术前血清促甲状腺激素对甲状腺乳头状癌颈侧区淋巴结转移的影响

Effect of preoperative serum thyroid stimulating hormone on lateral lymph node metastasis in pa- pillary thyroid carcinoma

目的：探讨术前血清促甲状腺激素（TSH）水平对甲状腺乳头状癌侧方淋巴结转移的影响。方法回顾性收集2011年1月至2014年5月间首诊收治以最终病理结果证实为甲状腺乳头状癌且行颈侧区淋巴结清扫的病例，阈值效应分析、多元Logistic回归分析等方法分析术前血清TSH对颈侧区淋巴结转移的影响。结果共收集157例甲状腺乳头状癌病例，术前平均TSH为（2．48±1．91）μIU／ml，术前血清TSH与侧方淋巴结转移存在相关性，阈值效应分析显示两者相互关系存在分段特征，在＜1．475μIU／ml时，随着TSH浓度的升高，颈侧区淋巴结转移风险升高，多因素Logistic回归显示该段 TSH 对颈侧区淋巴结转移具有独立作用。血清 TSH 浓度＞1．475μIU／ml时，并无上述结果。结论术前血清TSH 对甲状腺乳头状癌颈侧区淋巴结转移可能存在影响，不同浓度的血清TSH对颈侧区淋巴结转移的影响不同，相关的机制尚不明确，宜进一步讨论。

Objective To investigate the effect of preoperative serum thyroid stimulating hormone（TSH）on lateral cervical lymph node metastasis（LCNM）in papillary thyroid carcinoma.Methods FromJanuary 2011 to May 2014,a retrospective analysis was performed in patients admitted in Wuhan TongjiHospital,who were diagnosed as papillary thyroid carcinoma by pathological result and received dissectionof lateral cervical lymph node.Threshold effect and multivariate logistic regression were accomplished toanalyze the effects of preoperative serum TSH on LCNM.Results A total of 157 patients were reviewed.The mean preoperative TSH was（2.48 ±1.91）μIU /ml.There was correlation between preoperative serumTSH and LCNMin these patients,and a threshold effect was noticed.In patients with TSH less than 1.475μIU /ml,the risk of LCNM increased with the elevation of serum TSH concentration.Multivariate logisticregression confirmed the independent effect of TSH on LCNM.But in other patients with TSH greater thanor equal to 1.475 μIU /ml,there were no similar results.Conclusion Preoperative serum TSH may affectLCNMand the influence is not the same when the TSH concentration is different.Further discussion is required for clarifying the specific mechanisms.