影响分化型甲状腺癌发生肺转移的相关因素分析

Analysis of related factors affecting lung metastasis in differentiated thyroid carcinoma

目的探讨分化型甲状腺癌（DTC）肺转移的相关影响因素，以早期对肺转移进行诊断。方法选取2016年7月至2018年6月沈阳军区总医院核医学科收治的405例DTC患者，收集患者的一般资料与临床资料，包括性别、年龄、临床病理类型、职业、环境状况、原发灶大小、促甲状腺激素（TSH）抑制情况、基因突变等。进行log-rank单因素分析及多因素logistic回归分析，根据多因素回归分析的结果建立回归方程，最后再对方程的预测正确率进行检验。结果405例DTC患者中，肺转移68例。单因素分析显示，吸烟及二手烟暴露情况、职业暴露史、体质量指数、病理类型、原发灶数目、甲状腺外组织侵犯、纵隔淋巴结转移是影响DTC肺转移的7个显著因素。多因素logistic回归显示，病理类型、原发灶数目、纵隔淋巴结转移及体质量指数是影响DTC肺转移的独立因素（P〈0．05）。结论病理类型、原发灶数目、纵隔淋巴结转移及体质量指数是影响DTC肺转移的相关因素。针对此类患者，临床上要加强重视，完善定期复查和随访工作。

Objective To investigate the related factors of lung metastasis of differentiated thyroid carcinoma,to predict the occurrence of lung metastasis, and to diagnose it early. Methods A retrospective study was performed on 405 cases of DTC patients who were admitted from July 2016 to June 2018. General and clinical data of the patients were collected, including gender, age, clinic pathologic type, occupation, en- vironmental status, primary lesion size, TSH inhibition and gene mutation. Single factor analysis of log-rank and multiple logistic regression analysis were performed. The regression equation was established based on the results of multiple regression analysis, and the prediction accuracy of the equation was tested. Results Among 405 DTC patients,68 had lung metastasis. Univariate analysis showed that smoking and secondhand smoke exposure ,occupational exposure, body mass index, pathological type, number of primary lesions,invasion of extraneous thyroid tissue and mediastinal lymph node metastasis were 7 significant factors influencing lung metastasis of DTC. Multiple Logistic regression analysis suggested that the pathological type, number of primary lesions, mediastinal lymph node metastasis and body mass index were independent factors influencing lung metastasis of DTC （P 〈 0. 05）. Conclusion Pathological type, number of primary lesions, mediastinal lymph node metastasis and body mass index are the related factors affecting DTC lung metastasis. In view of this kind of patients, clinical attention should be strengthened to improve the regular review and follow-up work.