甲状腺乳头状癌合并桥本甲状腺炎与患者颈侧区淋巴结转移的关联研究  

Association study between papillary thyroid carcinoma combined with Hashimoto´s thyroiditis and lateral lymph node metastasis in patients

作　　者：刘淑珍 王俊 李纪男 LIU Shuzhen;WANG Jun;LI Jinan(Department of Thyroid Surgery,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China)

机构地区：[1]锦州医科大学附属第一医院甲状腺外科,锦州121000

出　　处：《中国免疫学杂志》2025年第3期661-667,共7页Chinese Journal of Immunology

基　　金：锦州市科技计划项目(JZ2023B051)。

摘　　要：目的:探究桥本甲状腺炎(HT)合并甲状腺乳头状癌(PTC)侧区淋巴结转移(LLNM)的危险因素及预测模型。通过多维度、系统性地探究其危险因素,构建精准且具有临床应用价值的预测模型,为临床诊疗、预后、手术实践决策评估提供依据。方法:回顾性分析2022年4月至2024年6月锦州医科大学附属第一医院甲状腺外科收治的201例HT合并PTC患者的临床资料,依据患者是否发生LLNM,分为转移组(n=82)和未转移组(n=119)。对比两组患者相关临床指标,采用单因素、多因素分析影响患者发生LLNM的独立危险因素,采用logistic回归建立预测模型,并评估预测价值。结果:单因素分析结果显示,两组患者TSH值、结节位置、结节回声、形状、边界、纵横比、肿瘤直径、多灶性、微钙化、结节富血供、ELN、CLNM、包膜侵犯、ETE的差异有统计学意义(P<0.05);多元logistic回归分析结果显示,肿瘤直径、CLNM、结节富血供、多灶性及TSH均为影响LLNM的独立危险因素(P<0.05);受试者工作特征(ROC)曲线分析显示,肿瘤直径、多灶性、CLNM、结节富血供及TSH的曲线下面积(AUC)依次为0.613(95%CI:0.533~0.693)、0.656(95%CI:0.578~0.733)、0.694(95%CI:0.619~0.768)、0.622(95%CI:0.543~0.701)和0.588(95%CI:0.510~0.667),灵敏度依次为72.20%、69.60%、65.80%、60.80%和41.80%,特异度依次为45.90%、62.30%、73.80%、60.70%和83.60%。结论:肿瘤直径、多灶性、CLNM、结节富血供及TSH与HT合并PTC患者发生LLNM显著相关,其中肿瘤直径、多灶性对于LLNM的灵敏度相对较高,对HT合并PTC患者发生LLNM具有一定的预测价值。Objective:To explore the risk factors and prediction model of lateral lymph node metastasis(LLNM)in Hashimoto's thyroiditis(HT)combined with papillary thyroid carcinoma(PTC).By investigating its risk factors in a multi-dimensional and systematic manner,a precise prediction model with clinical application value will be constructed to provide a basis for clinical diagnosis and treatment,prognosis assessment,and surgical practice decision evaluation.Methods:A retrospective analysis was conducted on the clinical data of 201 patients with HT combined with PTC who were admitted to the Thyroid Surgery Department of the First Affiliated Hospital of Jinzhou Medical University from April 2022 to June 2024.According to whether the patients had LLNM,they were divided into a metastasis group(n=82)and a non-metastasis group(n=119).The relevant clinical indicators of the two groups of patients were compared.Univariate and multivariate analyses were used to identify the independent risk factors affecting the occurrence of LLNM in patients.A logistic regression was employed to establish a prediction model and evaluate its predictive value.Results:The results of univariate analysis showed that there were statistically significant differences between the two groups in terms of TSH value,nodule location,nodule echo,shape,boundary,aspect ratio,tumor diameter,multifocality,microcalcification,rich blood supply of nodules,ELN,CLNM,capsule invasion,and ETE(P<0.05).The results of multivariate logistic regression analysis indicated that tumor diameter,CLNM,rich blood supply of nodules,multifocality,and TSH were all independent risk factors for LLNM(P<0.05).The receiver operating characteristic(ROC)curve analysis demonstrated that the areas under the curve(AUC)of tumor diameter,multifocality,CLNM,rich blood supply of nodules,and TSH were 0.613(95%CI:0.533~0.693),0.656(95%CI:0.578~0.733),0.694(95%CI:0.619~0.768),0.622(95%CI:0.543~0.701)and 0.588(95%CI:0.510~0.667),respectively.The sensitivities were 72.20%,69.60%,65.80%,60.80% and 41.80%,res

关 键 词：甲状腺乳头状癌(PTC) 桥本甲状腺炎(HT) 颈侧区淋巴结转移(LLNM) 列线图 危险因素 验证 

分 类 号：R736.1[医药卫生—肿瘤]