甲状腺乳头状癌合并桥本甲状腺炎患者外周血T细胞亚群特征性的分析

Specificity of peripheral blood T cell subsets of papillary thyroid cancer patients associated with Hashimoto thyroiditis

目的:分析甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)的患者外周血T细胞亚群与甲状腺相关抗体及临床资料的相关性,探究PTC合并HT的患者T细胞亚群的特异性,并为其免疫状态提供参考。方法:选择2016年2月至2019年5月于天津医科大学总医院行手术治疗的100例PTC患者纳入此次研究,按其病理类型及是否合并桥本甲状腺炎分为PTC合并HT组(n=50)及单纯PTC组(n=50),用流式细胞术分析患者入院时外周血CD4^+、CD8^+T细胞亚群的比例,计算CD4^+/CD8^+T细胞比值,测定患者外周血甲状腺相关抗体,结合临床资料进行统计学分析。结果:两组患者性别占比差异有统计学意义(P<0.05);肿瘤腺外侵犯PTC组明显多于PTC合并HT组(P<0.05);淋巴结转移率PTC合并HT组多于PTC组(P<0.05);PTC组TgAb、TPOAb水平均明显低于PTC合并HT组(均P<0.05);PTC合并HT组T淋巴细胞亚群较单纯PTC组无明显变化,但CD4^+/CD8^+与临床分期相关。PTC合并HT组CD4^+T细胞与TRAb呈负相关,CD8^+T细胞与TRAb呈正相关,CD4^+/CD8^+与TRAb呈负相关(P<0.05),而PTC组则未显示有相关性。PTC合并HT组中低CD4^+/CD8^+亚组(CD4^+/CD8^+≤1.5)与高CD4^+/CD8^+亚组(CD4^+/CD8^+>1.5)相比,平均年龄和AJCC分期均偏低(P<0.05),而PTC组中低CD4^+/CD8^+亚组与高CD4^+/CD8^+亚组相比年龄和AJCC分期差异无统计学意义。结论:合并HT的低龄PTC患者外周血T细胞CD4^+/CD8^+值更小,肿瘤AJCC分期更低,提示细胞免疫水平对甲状腺乳头状癌的进展及预后有一定影响。

Objective:To analyze the correlation between peripheral blood T cell subsets and thyroid-related antibodies and clinical data in papillary thyroid carcinoma(PTC)patients accompanied by Hashimoto thyroiditis(HT),to explore the specificity of T cell subsets in patients with PTC and HT,and to provide a reference for their immune status.Methods:One hundred postoperative patients with papillary thyroid cancer in our hospital from February 2016 to May 2019 were included in this study.They were divided into PTC with HT group(n=50)and PTC group(n=50).The ratio of CD4^+and CD8^+T cell subsets in peripheral blood of patients at admission was analyzed by flow cytometry,and the ratio of CD4^+/CD8^+T cells was calculated.The peripheral blood thyroid-related antibodies were determined,then statistical analysis was performed combined with clinical data.Results:According to the analysis on basic clinical data,there was a difference in the sex ratio between PTC with HT group and PTC group(P<0.05);the PTC group with extraglandular tumor invasion was significantly more than that of the PTC with HT group(P<0.05);the lymph node metastasis rate of PTC with HT group was more than that of the PTC group(P<0.05).The levels of TgAb and TPOAb antibodies in the PTC group were significantly lower than those in the PTC with HT group(P<0.05).Among patients with PTC and HT,T lymphocyte subsets had no significant changes compared with patients only with simple PTC,but the CD4^+/CD8^+ratio was related to clinical stage.CD4^+T cells in the PTC with HT group were negatively correlated with TRAb,CD8^+T cells were positively correlated with TRAb,CD4^+/CD8^+was negatively correlated with TRAb(P<0.05),while the PTC group showed no correlation.Analysis of the relationship between T cell subsets and clinical data in the two groups revealed that,in the PTC with HT group,the low CD4^+/CD8^+subgroup(CD4^+/CD8^+≤1.5)had a lower average age and AJCC stage(P<0.05)in comparison with high CD4^+/CD8^+subgroup(CD4^+/CD8^+>1.5).In the PTC group,there was no significant difference in age and AJCC stage between the two subgroup.Conclusion:The peripheral blood T cell CD4/CD8 ratio is smaller and tumor stage is lower in patients with HT at an younger age,suggesting that cellular immune level has a certain effect on the progression and prognosis of papillary thyroid carcinoma.