甲状腺结节伴乳头状癌临床特征及恶性风险因素分析

Clinical characteristics and risk factors of papillary thyroid carcinoma in patients with thyroid nodules

目的探讨甲状腺结节伴乳头状癌（papillary thyroid cancinoma,PTC）的临床特征和危险征象。方法 409例首次行甲状腺结节手术患者,经组织病理确诊PTC 175例（PTC组）,甲状腺良性结节234例（良性组）,回顾性分析2组临床资料,比较甲状腺超声及甲状腺血清学特点,logistic回归分析PTC的独立危险征象。结果 PTC组中位年龄（44岁）低于良性组（51岁）（P〈0.01）;甲状腺超声显示PTC组2个结节（17.7%）、实性结节（61.7%）、结节直径≤2cm（72.6%）、低回声（61.7%）、边界不清（43.4%）、形态不规则（59.4%）及微小钙化率（62.8%）高于良性组（8.1%、50.4%、42.3%、41.5%、17.9%、18.8%、22.2%）（P〈0.05）;PTC组抗甲状腺球蛋白抗体（3.6（0.0,596.0）u/mL）高于良性组（3.0（0.0,423.0）u/mL）（P〈0.05）;年龄≤40岁（OR=0.969,95%CI：0.951～0.987,P=0.001）、结节形态不规则（OR=4.176,95%CI：2.572～6.780,P=0.000）、微小钙化（OR=2.487,95%CI：1.528～4.049,P=0.000）、结节数目（OR=1.403,95%CI：1.035～1.901,P=0.029）及结节直径（OR=0.702,95%CI：0.579～0.852,P=0.000）是PTC的独立危险征象。结论 PTC好发于40岁以下患者,超声声像中结节形态不规则、微小钙化、结节直径有助于术前判断PTC。

Objective To explore the clinical characteristics and risk factors of papillary thyroid carcinoma（PTC）in patients with thyroid nodules.Methods A total of 409 patients with thyroid nodules undergoing first thyroidectomy included 175 patients with pathologically confirmed PTC（PTC group）and 234 patients with benign thyroid nodules（control group）.The clinical data were retrospectively analyzed to compare sonographic imagings and laboratory results between two groups.The independent risk factors of PTC were studied by logistic regression analysis.Results The median age was lower in PTC group（44 years old）than that in control group（51 years old）（P〈0.01）.The rates of sonographic images of two nodules（17.7%）,solid nodule（61.7%）,nodular diameter≤2cm（72.6%）,low-level echo（61.7%）,blurred margin（43.4%）,irregular shape（59.4%）and microcalcification（62.8%）were higher in PTC group than those in control group（8.1%,50.4%,42.3%,41.5%,17.9%,18.8%,22.2%）（P〈0.05）.The level of antithyroglobulin antibodies in PTC group（3.6（0.0,596.0）u/mL）was higher than that in control group（3.0（0.0,423.0）u/mL）（P〈0.05）.The age ≤40years（OR=0.969,95% CI：0.951 to 0.987,P=0.001）,irregular shape（OR=4.176,95%CI：2.572 to 6.780,P=0.000）,microcalcification（OR=2.487,95%CI：1.528 to 4.049,P=0.000）,nodule number（OR=1.403,95% CI：1.035 to 1.901,P=0.029）and nodular diameter（OR=0.702,95%CI：0.579 to 0.852,P=0.000）were independent risk factors of PTC.Conclusion PTC often occurs in those under 40 years old.Sonographic finding contributes to its preoperative diagnosis.