体重指数与甲状腺乳头状癌患病风险的相关性研究

Association of body mass index and the risk of papillary thyroid carcinoma

目的探讨体重指数（BMI）与甲状腺乳头状癌（PTC）患病风险的相关性。方法收集1994年1月至2013年12月本院收治并行手术治疗、病理结果明确的4350例甲状腺结节患者临床资料．根据BMI将患者分为正常体重组（BMI18．5～23．9kg／m。）、超重组（BMI24．0～27．9kg／m2）和肥胖组（BMI≥28．0kg／Ill。），根据病理结果分为良性结节组和乳头状癌组，分析组间年龄、性别构成、结节大小、血清TSH水平、超重和肥胖构成比的差异，采用logistic回归分析评价甲状腺乳头状癌的危险因素。结果（1）与良性结节组相比，乳头状癌组中≤40岁患者所占比例更高（34．1％对19．5％，P〈0．01）、血清TSH水平更高[1．9（1．2—3．0）mU／L对1．6（0．9—2．5）mU／L，P〈0．01]，及结节直径更小[1．0（0．7。2．0）cm对3．0（2．0～4．0）cm，P〈0．01]；（2）在男性患者中，肥胖者比例在乳头状癌组中明显于良性结节组（28．7％对20．7％，P〈0．01），但女性患者中未见明显差异；（3）根据性别、年龄分层，与良性结节组相比，≤40岁男性乳头状癌患者中超重（49．4％对44．1％，P〈0．05）和肥胖（26．5％对15．3％，P〈0．01）者比例均明显升高：41～65岁男性乳头状癌患者中肥胖者比例高于良性结节组（30．8％对22．2％，P〈0．01）；（4）Logistic回归分析显示超重（DR=4．947）和肥胖（OR=7．648）仅与≤40岁男性乳头状癌患病风险增加有关（P〈0．01）。结论超重和肥胖是≤40岁男性甲状腺结节患者发生乳头状癌的独立危险因素。

Objective To investigate the correlation between body mass index （BMI） and the occurence of papillary thyroid carcinoma （ PTC ） among the patients with thyroid nodules. Methods This cross-sectional study collected the data of 4 350 patients with thyroid nodules who underwent thyroidectomy in our hospital from January 1994 to December 2013. The patients were divided into normal weight （ BMI 18.50 - 23.9 kg/m2 ）, overweight （ BMI 24.0 - 27.9 kg/m2 ） , and obese （ BMI ≥28.0 kg/m2 ） groups according to BMI, as well as benign nodules and papillary thyroid carcinoma groups based on their pathological finding. The differences of age-sex composition, nodule diameter, TSH level, overweight and obese constituent ratio between two groups were also analyzed. Logistic regression method was used to evaluate the risk factors of PTC. Results （ 1 ） Compared with the benign nodule group, there was a higher proportion of patients under the age of 40 years （ 34.1% vs 19.5 % , P〈0.01 ） in PTC group, with smaller turnout diameters [ 1.0 （0.7-2.0） cm vs 3.0 （2.0-4.0） cm, P〈0.01 ] and higher TSH levels [ 1.9 （ 1.2- 3.0） mU/L vs 1.6 （0.9-2.5） mU/L, P〈0.01]. （ 2 ） The proportion of obese patients was higher in PTC group than that in the benign nodule group （28.7% vs 20.7% , P〈0.01 ） among male patients. While the difference was not found among female patients. （ 3 ） Stratification analysis according to gender and age showed that the proportion of overweight （49.4 % vs 44.1%, P〈0.05 ） or obese （26.5 % vs 15.3 %, P〈0.01 ） in PTC group was higher than that of benign nodule group among male patients aged 〈~40 years and the proportion of obese patients in PTC group was higher than that of benign nodule group （30.8% vs 22.2%, P〈0.01 ） among male patient aged 41 to 65 years. （4） A multivariate analysis indicated that overweight （ OR = 4. 947 ） and obesity （ OR = 7. 648 ） were all independent risk factors for PTC （ P〈0.01 ） among male patients aged ≤40 years. Conclusion Overweight and obesity are associated with higher PTC risk for male patients aged 40 years or less.