血清促甲状腺激素浓度与分化型甲状腺癌的关系研究

Study on correlation between thyroid stimulating hormone and differentiated thyroid cancer

目的 研究术前血清促甲状腺激素浓度（thyroid stimulating hormone,TSH）与分化型甲状腺癌（differentiated thyroid cancer,DTC）之间的关系.方法 选取2012年5月～2013年5月浙江医院分院普外科收录的388例符合条件的甲状腺结节患者进行回顾分析,研究其手术前血清中TSH差异.对照分析不同TSH浓度下分化型甲状腺癌的发病比例及病理类型、颈淋巴结转移、病变处肿瘤直径大小与TSH浓度的关系.结果 分化型甲状腺癌患者血清TSH水平为（2.94±1.74） mU/L,明显高于良性甲状腺结节患者的（1.92±1.45） mU/L（P ＜0.01）.分化型甲状腺癌的发病比例随TSH浓度升高亦升高,TSH＜0.27、0.27 ～1.44、1.45 ～2.19、2.20 ～4.20和＞4.20 mU/L组患分化型甲状腺癌比例分别为26.3％、34.2％、40.6％、63.1％和75.0％.伴有颈淋巴结转移的患者血清TSH水平（4.94±1.43） mU/L要明显高于未见转移的患者（2.71±1.01）mU/L（P ＜0.05）;随着病变处肿瘤直径变大（＜2cm,2～4cm和＞4 cm）,TSH水平提高（P＜0.05）.结论 血清中TSH浓度的增高对甲状腺结节患者患分化型甲状腺癌患病率有一定影响,且浓度越高其患病率就越大.手术前进行血清TSH浓度水平测量已经成为预测分化型甲状腺癌的一种重要手段.

Objective To study preoperative serum concentration of thyroid stimulating hormone（ TSH） and its relationship with differentiated thyroid cancer（ DTC）. Methods 388 cases with thyroid nodules recorded from May 2012 to May 2013 in department of general surgery of Zhejiang Hospital Branch were randomly selected and retrospective analysed. The concentration changes of serum TSH before surgery were compared. The rates of patients with differentiated thyroid cancer were analysed at different TSH levels,and the relationship of pathological pattern,cervical lymph node metastasis,size of tumor and TSH level were compared respectively. Results The serum TSH levels of differentiated thyroid cancer patients was（ 2. 94 ±1. 74） m U/L,which was higher than（ 1. 92 ± 1. 45） m U / L of patients with benign thyroid nodules,and the difference was statistically significant（ P〈 0. 01）. The proportion of patients with differentiated thyroid cancer elevated with TSH level increasing,and levels of TSH 〈0. 27 m U / L（ 26. 3%）,0. 27 ~ 1. 44 m U / L（ 34. 2%）,1. 45 ~ 2. 19 m U / L（ 40. 6%）,2. 20 ~ 4. 20 m U / L（ 63. 1%）,and 〉4. 20 m U / L（ 75. 0%）. The TSH level of DTC patients with cervical lymph node metastasis was（ 4. 94 ± 1. 43） m U / L,which was higher than（ 2. 71 ± 1. 01） m U / L without cervical lymph node metastasis（ P〈 0. 05）. The TSH level of DTC patients elevated with tumor size（ 〈2 cm,2 ~ 4 cm 和 〉4 cm） increasing（ P〈 0. 05）. Conclusion Serum TSH levels can affect the prevalence rate of DTC in patients with thyroid nodules,and the higher of concentration,the higher of its prevalence rate. Before operation,the measurement of serum TSH levels has become an important means to predict DTC.