分化型甲状腺癌颈部淋巴结转移的相关危险因素分析

Analysis of relative risk factors for cervical lymph node metastasis of differentiated thyroid cancer

目的分析分化型甲状腺癌(DTC)患者的超声及实验室检查结果,探讨影响DTC颈部淋巴结转移的因素。方法选取2019-01~2019-12于该院接受手术治疗且经术后病理确诊为DTC的133例患者资料,根据术后病理结果是否存在颈部淋巴结转移分为转移组(78例)和无转移组(55例)。收集两组患者的一般临床资料、实验室检查资料及超声检查资料并进行比较,采用多元Logistic回归分析影响DTC颈部淋巴结转移的因素。结果与无转移组相比,转移组的男性人数比例较大,年龄较小,有结节内钙化的人数比例及结节直径较大,差异有统计学意义(P<0.05)。转移组血清促甲状腺激素(TSH)水平、抗甲状腺球蛋白抗体(TGAb)阳性率和抗甲状腺过氧化物酶自身抗体(TPOAb)阳性率高于无转移组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,发生结节内钙化、TGAb阳性和较大的结节直径是促进DTC颈部淋巴结转移发生的危险因素(P<0.05),而较高的年龄和女性是DTC颈部淋巴结转移发生的保护因素(P<0.05)。结论男性、年龄小、结节直径大、结节内钙化、TGAb阳性是DTC患者发生颈部淋巴结转移的危险因素,术前完善超声及血清学检查对指导DTC手术及预后评估有重要意义。

Objective To analyze the ultrasound and laboratory examination results of patients with differentiated thyroid cancer(DTC),and to explore the factors affecting cervical lymph node metastasis of DTC.Methods The data of 133 patients who underwent surgical treatment in our hospital from January 2019 to December 2019 and were diagnosed with DTC by postoperative pathology were selected and the patients were divided into metastasis group(78 cases)and non-metastasis group(55 cases)according to whether there was cervical lymph node metastasis confirmed by pathology results.The general clinical data,laboratory examination data and ultrasonic examination data in the two groups were collected and were compared between the two groups.The factors affecting DTC cervical lymph node metastasis of DTC were analyzed by multivariate Logistic regression.Results Compared with the non-metastasis group,the metastasis group had larger proportion of male,younger patients,larger proportion of the patients with intranodular calcification and larger diameter of the nodules,and the differences were statistically significant(P<0.05).The levels of serum thyroid stimulating hormone(TSH),the positive rates of anti-thyroglobulin antibodies(TGAb)and anti-thyroid peroxidase antibody(TPOAb)in the metastasis group were higher than those in the non-metastasis group,and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that the occurrence of intranodular calcification,positive TGAb,and larger diameter of the nodules were the risk factors for promoting the occurrence of cervical lymph node metastasis of DTC(P<0.05);while higher age and female were the protective factors for cervical lymph node metastasis of DTC(P<0.05).Conclusion Male,low age,large diameter of the nodules,intranodular calcification,and positive TGAb are the risk factors for the occurrence of cervical lymph node metastasis in the patients with DTC.The necessary preoperative ultrasonic and serological examinations are of great significance to guide DTC operation and prognosis assessment.