中性粒细胞与淋巴细胞比值及甲状腺球蛋白抗体水平与甲状腺乳头状癌颈部淋巴结转移的相关性分析

The correlation between neutrophils/lymphocytes ratio,levels of thyroglobulin antibody and thyroid papillary carcinoma cervical lymph node metastasis

目的分析中性粒细胞与淋巴细胞比值(NLR)及甲状腺球蛋白抗体水平(Tg Ab)与甲状腺乳头状癌颈部淋巴结转移的相关性。方法回顾性收集2015年1月1日至2016年12月31日于扬州大学附属医院甲乳外科行甲状腺乳头状癌手术者,病理诊断为甲状腺乳头状癌(包括甲状腺微小乳头状癌),接受单侧或双侧腺叶全切联合中央组淋巴结清扫术者200例且临床资料完善者纳入此次研究。于入院后手术前测定病人血常规、血糖、尿酸、尿素氮、肌酐、胱抑素C、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体水平。单因素分析上述指标与甲状腺乳头状癌颈部淋巴结转移的相关性,将上述参数中差异有统计学意义的指标纳入logistic回归模型中,从logistic回归模型中筛选出甲状腺乳头状癌颈部淋巴结转移的危险因素作ROC曲线,评价其检出效能。结果单因素分析,病人年龄(> 45岁)、肿瘤直径(> 1cm)、NLR、血小板分布宽度(PDW)、尿酸、尿素氮、肌酐及甲状腺球蛋白抗体水平的升高与甲状腺乳头状癌颈部淋巴结转移差异有统计学意义(P <0. 05)。logistic回归模型中显示以下3个因素:年龄(> 45岁)、NLR及甲状腺球蛋白抗体的增高为甲状腺乳头状癌颈部淋巴结转移的危险因素。将上述三个因素与甲状腺乳头状癌颈部淋巴结转移作ROC曲线,以NLR的曲线下面积最大(曲线下面积为0. 716)。结论病人年龄(> 45岁)、NLR及甲状腺球蛋白抗体的增高为甲状腺乳头状癌颈部淋巴结转移的高危因素,以NLR检出效能最高。

Objective To investigate the value of neutrophils/lymphocytes ratio(NLR) and levels of thyroglobulin antibody(Tg Ab)for predicting cervical lymphnode metastasis in thyroid papillary carcinoma(PTC). Methods 200 patients who received thyroid surgery and diagnosed as PTC(including thyroid papillary microcarcinoma) were retrospectively collected from January 1st of 2015 to December 31 st of 2016 in the Thyroid Breast Surgery department of the affiliated hospital of Yangzhou University. Blood routine examination and levels of blood glucose,urea nitrogen,creatinine,uric acid,cystatin C,cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein,thyroglobulin antibody and thyroid peroxidase antibody were tested before surgry. Risk factors correlated with PTC cervical lymphnode metastasis were screened with single factor analysis and logistic regression model. Detection efficiency of risk factors was assessed with ROC curve. Results In single factor analysis,patients’ age(> 45 years),tumor diameter(> 1 cm),and increased levels of NLR,PDW,uric acid,urea nitrogen,creatinine,and thyroglobulin antibody were significantly related to PTC cervical lymph node metastasis. In logistic regression model,age(> 45 years),NLR and the increase of thyroglobulin antibody were risk factors for PTC cervical lymphnode metastasis(P < 0. 05). ROC curve were plotted by age(> 45 years),NLR,thyroglobulin antibody and PTC cervical lymph node metastasis,and the maximum area under the curve was 0. 716 by NLR. Conclusion Age(> 45 years)and increasing levels of NLR and thyroglobulin antibody were risk factors of PTC cervical lymphnode metastases,but NLR showed the highest detection efficiency.