血清TRAb水平对原发性甲状腺功能亢进合并甲状腺乳头状癌的临床价值

Clinical Value of Serum TRAb in Primary Hyperthyroidism Complicated with Papillary Thyroid Carcinoma

目的探讨原发性甲状腺功能亢进合并甲状腺乳头状癌发生淋巴结转移的危险因素。方法对2012年2月至2017年10月在华中科技大学同济医学院附属同济医院行手术治疗的原发性甲状腺功能亢进合并甲状腺乳头状癌患者35例进行回顾性分析,发生淋巴结转移的17例为淋巴结转移组,未发生颈部淋巴结转移的18例为对照组。比较两组的临床特征(性别、年龄、突眼)、生化指标[促甲状腺激素、促甲状腺激素受体抗体(TRAb)、过氧化物酶抗体、甲状腺球蛋白抗体]、病理特征(肿瘤大小、单侧/双侧、单发/多发、甲状腺包膜外侵犯以及BRAF基因表达、雌激素受体ER表达)之间的区别。结果原发性甲状腺功能亢进合并甲状腺乳头状癌发生淋巴结转移组除血清TRAb水平高于对照组外(P<0.05),其余指标两组间差异均无统计学意义。Logistic回归分析显示TRAb水平是原发性甲状腺功能亢进合并甲状腺乳头状癌发生淋巴结转移的独立危险因素(P<0.05)。结论 TRAb可能是原发性甲状腺功能亢进合并甲状腺乳头状癌转移、复发等预后不良的风险因素之一。

Objective To explore risk factors of lymph node metastasis of primary hyperthyroidism with papillary thyroid carcinoma.Methods In total,35patients diagnosed as primary hyperthyroidism with papillary thyroid carcinoma by pathological examination were selected from Department of Thyroid and Breast Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from February2012to October2017.Among them,17cases with lymph node metastasis were considered as study group,18cases without lymph node metastasis as control group.The gender,age,exophthalmos,thyroid stimulating hormone,thyroid hormone receptor antibody(TRAb),peroxidase antibodies,thyroglobulin antibodies,and pathological features(tumor size,unilateral/bilateral,single/multiple,extrathyroid invasion,BRAF gene expression,estrogen receptor expression)were compared between the two groups.Results TRAb was significantly higher in the study group than in control group(P<0.05),the other indicators were not significantly different.Logistic regression showed that TRAb was the risk factor of lymph node metastasis of primary hyperthyroidism with papillary thyroid carcinoma(P<0.05).Conclusion TRAb may be one of the risk factors for lymph node metastasis and suggest poor prognosis of primary hyperthyroidism complicated with papillary thyroid carcinoma.