硒与甲状腺癌风险相关性研究

Study on the correlation between selenium and thyroid cancer risk

目的研究乌鲁木齐人群硒营养状态与甲状腺癌的相关性。方法收集2014年3月-2014年12月新疆医科大学第一附属医院血管甲状腺外科收治的140例甲状腺癌患者(甲状腺癌组)及147例良性甲状腺结节患者(甲状腺良性结节组)的临床资料,另收集同期甲状腺形态正常的健康体检者315例(甲状腺形态正常组),记录其一般资料、血硒、血清甲状腺功能和甲状腺自身抗体检测水平,进行统计学分析。将602例研究对象按血硒水平分为≤50.00μg/L、51.01~100.00μg/L、100.01~150.00μg/L、150.01~200.00μg/L和>200.00μg/L 5组,分析比较5组甲状腺癌患者血硒水平是否存在差异。结果甲状腺癌组和甲状腺良性结节组患者平均年龄高于甲状腺形态正常组;甲状腺癌组平均年龄显著低于甲状腺良性结节组(t=-5.666,P<0.001)。3组血清总三碘甲状原氨酸(TT_3)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TgAb)和甲状腺过氧化物酶抗体(TPOAb)的检测水平差异有统计学意义(P<0.001,P=0.020)。甲状腺癌组TT_3检测水平较甲状腺形态正常组低,TSH、TgAb、TPOAb检测水平高于甲状腺形态正常组,差异有统计学意义(P<0.001,P=0.01)。3组血硒水平差异有统计学意义(Z=134.625,P<0.001)。甲状腺癌组血硒水平低于甲状腺形态正常组和甲状腺良性结节组,差异有统计学意义(Z值分别为-10.287、-2.130,P均<0.05)。甲状腺癌患者血硒水平存在差异,其中血硒水平≤50.00μg/L的甲状腺癌患者所占比例(54.7%)最高。随着血硒水平升高,TT_3逐渐上升,TSH、TPOAb逐渐下降。多因素Logistic回归分析结果示低血硒水平是甲状腺癌独立危险因素(P<0.001)。结论低硒可能增加新疆乌鲁木齐地区人群甲状腺癌风险,低硒可能通过影响甲状腺激素水平和甲状腺自身免疫反应诱导甲状腺癌发生,增加硒的摄入可能有助于防治甲状腺癌,但需进一步研究证实。

Objective To study the correlation between selenium nutritional status and thyroid cancer of Urumqi population.Methods A total of 140 patients with thyroid carcinoma and 147 patients with benign thyroid nodules from Department of Vascular and Thyroid Surgery,The First Affiliated Hospital of Xinjiang Medical University,and 315 cases of normal thyroid from health examination were collected in March2014 to December 2014,recording their general information,blood selenium,serum thyroid function and thyroid autoantibodies detection level for statistical analysis.Results The average age of the patients with thyroid cancer and benign thyroid nodules group was higher than that of the normal thyroid group,and that of the thyroid cancer group was significantly lower than that of the thyroid benign nodules group（t=-5.666,P〈0.001）.The difference of the levels of the serum TT3,TSH,TgAb,TPOAb in the three groups was statistically significant（P〈0.001,P =0.020）.TT3 level in the thyroid cancer group was lower than in the normal thyroid group,while TSH,TgAb,TPOAb levels were higher than in the normal thyroid group,and the difference was statistically significant（P〈0.001,P =0.01）.The blood selenium levels difference of the three groups was statistically significant（Z =134.625,P〈0.001）.The blood selenium level of the thyroid cancer group was lower than that of the normal and benign thyroid nodules group,and the difference was statistically significant（Z =-10.287 and-2.130 respectively,P〈0.05）.Based on the blood selenium levels,the 602 cases can be divided into five groups：50.00μg/L,51.01 to100.00μg/L,100.01 to 150.00μg/L,150.01 to 200.00μg/L and200.00μg/L.The blood selenium levels in patients with thyroid cancer were different,in which the percentage of thyroid cancer patients with blood selenium ≤50.00μg/L was the highest（54.7%）.With the increase of blood selenium levels,TT3 gradually increased,while TSH and TPOAb decreased.Multiariable Logistic regression analysis showed low blood selenium level was an independent risk factor for thyroid cancer（P〈0.001）.Conclusion People with low selenium may increase the risk of suffering thyroid cancer in Xinjiang Urumqi region,low selenium may impact on the thyroid hormone levels and thyroid autoimmune reaction to induce thyroid carcinoma,and increased selenium intake may contribute to prevent and treat thyroid cancer,but further studies is needed to confirm.