桥本甲状腺炎合并甲状腺癌的临床特征分析

The clinical features of Hashimoto thyroiditis with thyroid cancer

目的分析桥本甲状腺炎合并甲状腺癌的临床特征，为正确诊断及治疗提供依据。方法回顾性分析87例桥本甲状腺炎合并甲状腺癌患者和105例桥本甲状腺炎患者的临床资料。结果在年龄〈30、30～39、40～49、50～59和≥60岁患者中，桥本甲状腺炎合并甲状腺癌所占的比例分别为1／3、47．5％（29／61）、51．4％（38／74）、36．0％（18／50）和1／4。在30～39岁和40～49岁患者中，桥本甲状腺炎合并甲状腺癌所占的比例高于≥60岁患者，但差异无统计学意义（x2=0．327、0．418，P〉0．05）。桥本甲状腺炎合并甲状腺癌患者和桥本甲状腺炎患者总甲状腺素（TT4）、促甲状腺激素（TSH）、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）比较差异有统计学意义（P〈0．05或〈0．01）。多因素Logistic回归分析结果表明，血清TT4减低和TSH、TgAb、TPOAb水平增高与桥本甲状腺炎合并甲状腺癌的发生独立相关（P〈0．05或〈0．01）。结论血清TT4减低，TSH、TgAb、TPOAb增高可增加桥本甲状腺炎合并甲状腺癌的风险。临床工作中，对于30～49岁的男性桥本甲状腺炎患者，应高度怀疑其合并甲状腺癌的可能性。

Objective To analyze the clinical features of Hashimoto thyroiditis with thyroid cancer, and provide scientific basis for clinical diagnosis and treatment. Methods The clinical data of 87 patients of Hashimoto thyroiditis with thyroid cancer and 105 patients of Hashirnoto thyroiditis were retrospectively analyzed. Results The rates of Hashimoto thyroiditis with thyroid cancer in age 〈 30, 30 - 39, 40 - 49, 50 - 59 and≥ 60 years were 1/3, 47.5% （29/61）, 51.4% （38/74）, 36.0% （18/50） and 1/4. The rates of Hashimoto thyroiditis with thyroid cancer in patients of age 30 - 39 years and 40 - 49 years were higher than that in patients of age ≥ 60 years, but there were no statistical differences （X2 = 0.327 and 0.418, P 〉 0.05）. There were statistical differences in total thyroxine （TT4）, thyroid stimulating hormone （TSH）, thyroglobulin antibody TgAb） and thyroid peroxidase antibody （TPOAb） levels between Hashimoto thyroiditis with thyroid cancer and Hashimoto thyroiditis, there were statistical differences （P 〈 0.05 or 〈 0.01）. Muhiariable Logistic regression analysis result showed that the decreased serum level of TT4 and the increased levels of TSH, TgAb and TPOAb were the correlated factors of Hashimoto thyroiditis with thyroid cancer （P 〈 0.05 or 〈 0.01）. Conclusions Low level of TT4 and high levels of TSH, TgAb and TPOAb may increase the risk of Hashimoto thyroiditis with thyroid cancer. The 30 - 49 years male patients with Hashimoto thyroiditis should be highly suspected of the possibility of mergerthyroid cancer.