甲状腺乳头状癌碘摄入与BRAFV600E突变的相关性研究

Association of iodine intake and BRAFV600E mutation in papillary thyroid carcinoma

目的研究甲状腺乳头状癌（ papillary thyroid carcinoma, PTC ）碘摄入水平与BRAFV600E突变及与PTC临床生物学特性的关系。方法收集天津地区PTC患者共159例，同地区甲状腺正常人群200例作为正常对照，采用砷铈催化分光光度法检测患者的尿碘水平，应用PCR检测患者BRAFV600E基因突变情况。结果PTC患者尿碘中位数（ median of urinary iodine, MUI）为336μg/L，正常对照组MUI为196μg／L，两组间尿碘值差异有统计学意义（P=0．004）。159例PTC患者中，101例为BRAFV600E突变型，58例为野生型，总体突变率63．5％。BRAFV600E基因型在不同的尿碘分组间差异有统计学意义（P=0．006），随着尿碘值增加，BRAFV600E突变率增加。BRAFV600E基因型分布与性别、年龄、肿瘤大小、腺外侵犯、是否合并结节性甲状腺肿等临床病理学参数无关（P〉0．05），而与颈部淋巴结转移（P=0．008）、合并桥本病（HT）（P=0．037）有关。结论高碘摄入可能是PTC发病的危险因素。在PTC患者中，高碘摄入可能是BRAFV600E突变的危险因素。在颈部淋巴结转移阳性、不合并桥本甲状腺炎的患者中，BRAFV600E突变率增加。

Objective To investigate the correlation between iodine intake, BRAF mutation in thyroid gland and clinical biologic characteristics in papillary thyroid carcinoma（PTC） cases. Methods A total of 159 PTC patients and 200 healthy controls were enrolled in this study. Urine iodine was tested, BRAFV600E mutation was detected by PCR. The correlation was analyzed between BRAF mutation and iodine intake, BRAF mutation and clinical biologic characteristics of PTC respectively. Results The median urinary iodine （MUI） of the patients and healthy controls was 336μg/L and 196μg/L respectively （P = 0. 004）. The overall prevalence of the BRAFV600E mutation in this series of PTC was 63.5%, showing a clear correlation of BRAFV600E mutation with iodine intake （ P = 0. 006）. There was no correlation of BRAFV600E mutation with age, gender, tumor size, extrathyroid extension or nodulor goiter in PTC （P〉0.05）. But there was a significant association of BRAFV600E mutation with lymph node metastasis （P=0.008 ） and Hashimoto＇s thyroiditis （P=0.037）. Conclusions High iodine intake may be a risk factor for PTC occurrence. In PTC cases, high iodine intake may be a risk factor of BRAFV600E mutation. BRAFV600E mutations increase both in PTC with cervical lymph node metastases and uncoexisting Hashimoto＇ s thyroiditis.