甲状腺乳头状癌合并桥本甲状腺炎的临床特征与BRAFV600E基因突变的相关性分析

Correlation of BRAFv600E mutation and clinical characteristics in coexistence of papillary thyroid carcinoma and Hashimoto＇s thyroiditis

目的总结甲状腺乳头状癌（PTC）合并桥本甲状腺炎（HT）的辅助检查、诊断等临床特征，分析BRAFV600E基因突变与PTC合并HT的相关性。方法回顾性分析2011年3月至2012年3月期间收治的合并HT的PTC患者（研究组50例）和未合并HT的PTC患者（对照组150例）的临床特征．并比较了两组患者的差异，对其BRAFV600E基因突变情况进行了对照分析。结果研究组中颈部超声检查对颈部淋巴结转移判断的敏感度为88．9％，特异度为50．0％；研究组中TSH、甲状腺球蛋白抗体及甲状腺过氧化物酶抗体水平均高于对照组（均P〈0．01），二者淋巴结转移率（36．0％对54．0％）及侧颈转移率（22．2％对63．0％）差异均有统计学意义（P=0．041，P=0．004）；BRAFv600E基因突变率在研究组及对照组中分别为34．0％和70．7％（P〈0．01）；研究组中BRAF基因突变与淋巴结转移有显著相关性（P〈0．01）。结论超声检查对于判断HT合并FFC患者颈部淋巴结转移情况的敏感性较好，特异性较差，需与术中快速冰冻病理结合以评估颈部淋巴结清扫范围；BRAFV600E基因突变在PTC合并HT中有所减少，使其淋巴结转移率有所降低，总体预后好。

Objective To investigate the correlation of BRAFV600Emutation with papillary thyroid carcinoma and coexisting Hashimoto＇s thyroiditis. Methods A retrospective analysis of clinical characteristics was made in 50 patients with PTC and coexisting HT（ research group） and 150 PTC patients （control group） from March, 2011 to March, 2012, regarding the difference in BRAFv600E mutation. Results In research group, the sensitivity of ultrasound in detecting lymphatic metastasis was 88.9% , while the specificity was 50.0% ; the levels of TSH, thyroid globulin antibody, and thyroid peroxidase antibody in research group were higher than those in control group （ all P〈 0.01 ）. Rates of lymphatic metastasis （36.0% vs 54.0% ） and metastasis in Ⅱ - V area（22.2% vs 63.0% ） showed statistically significant differences between research group and control group （P = 0. 041, P = 0. 004 ）. The respective rates of mutation of BRAFV600Ein two groups were 34.0% and 70.7%, showing significant difference （P〈0.01）. There was a significant correlation between BRAFv600E mutation and lymphatic metastasis in research group （ P 〈 0.01 ）. Conclusions The sensitivity of ultrasound in detecting lymphatic metastasis of PTC is quite satisfactory while with its poor specificity. Combination of ultrasound with the fast frozen section pathology may help assess the scope of surgery. Reduced BRAFV600Emutation in PTC with coexisting HT results in reduction of lymphatic metastasis and may help to improve the prognosis of patients.