甲状腺结节中预测甲状腺乳头状癌的多因素分析:甲状腺球蛋白抗体的意义

A Multivariate Analysis of Predictors of Papillary Thyroid Carcinoma in Thyroid Nodules: Significance of Thyroglobulin Antibody

目的探讨甲状腺结节患者甲状腺自身抗体与甲状腺乳头状癌(papillary thyroid carcinoma,PTC)发生风险之间的相关性。方法回顾性分析2012年1月~2014年12月我院2128例因甲状腺结节行手术治疗的临床和病理资料,其中PTC 807例(37.9%),良性结节1321例(62.1%)。采用logistic回归分析,评价年龄、性别、病理诊断的慢性淋巴细胞性甲状腺炎(chronic lymphocytic thyroiditis,CLT)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、促甲状腺激素(thyroid stimulating hormone,TSH)等因素与PTC发生风险的相关性。结果与良性结节组相比,PTC组年龄更小[中位数43(四分位数33,53)岁vs.51(39,59)岁,P=0.000],合并CLT的比率更高[27.1%(219/807)vs.12.7(168/1321),P=0.000],TGAb阳性比率更高[26.6%(215/807)vs.13.7%(181/1321),P=0.000],TPOAb阳性比率更高[26.0%(210/807)vs.18.8%(249/1321),P=0.000],血清TSH水平更高[1.67(1.11,2.37)m IU/L vs.1.42(0.91,2.12)m IU/L,P=0.000]。多因素logistic回归分析显示,合并CLT(OR=1.843,95%CI:1.375~2.471,P=0.000)及TGAb阳性(60~99 U/ml组OR=2.005,95%CI:1.237~3.249,P=0.005;≥500 U/ml组OR=2.146,95%CI:1.281~3.594,P=0.004)与PTC发生风险独立相关,而TPOAb阳性与PTC发生风险未见独立相关;此外,PTC的发生风险随TSH水平的升高而增加。结论甲状腺结节合并CLT、TGAb阳性及TSH水平升高与PTC发生风险增加相关。

Objective To investigate the association of thyroid autoantibodies with papillary thyroid carcinoma（ PTC） in patients with thyroid nodules. Methods We retrospectively analyzed clinical and pathological data in 2128 patients with thyroid nodules who underwent thyroidectomy at our hospital from January 2012 to December 2014. Among the 2128 patients enrolled,807（ 37. 9%） patients were diagnosed as PTC and 1321（ 62. 1%） patients were classified into benign nodules. Logistic regression analysis was used to assess whether risk of PTC was associated with other clinical and pathological data,including age,sex,pathologically defined chronic lymphocytic thyroiditis（ CLT）,thyroglobulin antibody（ TGAb）,thyroid peroxidase antibody（ TPOAb）,and thyroid stimulating hormone（ TSH,thyrotropin）. Results As cpmpared with patients with benign nodules,those with PTC had a younger age [M = 43（ Q1= 33,Q3= 53） years old vs. 51（ 39,59） years old,P = 0. 000],higher rate of coexisting CLT [27. 1%（ 219 /807） vs. 12. 7%（ 168 /1321）,P = 0. 000],higher rate of positive TGAb [26. 6%（ 215 /807） vs. 13. 7%（ 181 /1321）,P =0. 000] and positive TPOAb [26. 0%（ 210 /807） vs. 18. 8%（ 249 /1321）,P = 0. 000] and higher level of serum TSH [1. 67（ 1. 11,2. 37） m IU/L vs. 1. 42（ 0. 91,2. 12） m IU/L,P = 0. 000]. Logistic analysis showed that coexistence of CLT（ OR = 1. 843,95% CI： 1. 375- 2. 471,P = 0. 001） and positivity of TGAb（ 60- 99 U / ml： OR = 2. 005,95% CI： 1. 237- 3. 249,P = 0. 005;≥500 U/ml： OR = 2. 146,95% CI： 1. 281- 3. 594,P = 0. 004）,but not positivity of TPOAb,were independently correlated with risk of PTC. Moreover,higher level of serum TSH was associated with an increased risk of PTC. Conclusion In patients with thyroid nodules,coexistence of pathologically defined CLT,positivity of TGAb,and elevation of TSH level are associated with increased risk of PTC.