甲状腺球蛋白与甲状腺微小乳头状癌的相关性分析

Analysis of correlation between thyroglobulin and papillary thyroid microcarcinoma

目的探讨血液中甲状腺球蛋白(thyroglobulin,Tg)水平与甲状腺微小乳头状癌(papillary thyroid microcarcinoma, PTMC)的关系。方法回顾性分析2017年1月至2019年8月安徽医科大学第二附属医院甲状腺与乳腺外科及宿州市立医院肿瘤外科就诊手术的TI-RADS 4b类直径≤1 cm单侧甲状腺肿块的患者共539例,依据患者术后病理结果分为PTMC组和良性肿瘤组,再依据病理结果有无颈部淋巴结转移(lymph node metastasis,LNM)将PTMC患者分为LNM组和无LNM组,分析术前血液中促甲状腺素(thyroid stimulating hormone,TSH)、甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)和Tg与PTMC及发生颈部LNM的关系。应用SPSS 21.0软件进行数据的统计分析。采用独立样本t检验方法比较PTMC组与良性肿瘤组,LNM组与无LNM组间各指标的关系。结果患者年龄、TSH、Tg及TgAb水平是PTMC的独立影响因素,其中年龄与PTMC呈负相关,TSH、Tg、TgAb与PTMC呈正相关(回归系数分别为:-0.020、0.192、0.026、0.008,95%CI分别为:0.962~0.998、1.045~1.404、1.015~1.038、1.003~1.014,P<0.05)。年龄和血清Tg水平是PTMC患者颈部LNM的独立影响因素,其中年龄与颈部LNM呈负相关,Tg与颈部LNM呈正相关(回归系数分别为:-0.025、0.014,95%CI分别为:0.957~0.994、1.008~1.021,P<0.05)。当血清Tg水平>26.520 ng/ml时提示≤1 cm的TI-RADS 4b类肿块为PTMC(敏感度:0.560,特异度:0.719);而Tg水平>36.695 ng/ml时提示此类PTMC患者伴有颈部LNM(敏感度:0.532,特异度:0.788)。结论血清Tg水平对临床鉴别≤1 cm的甲状腺肿块的良恶性具有重要意义,同时其也与PTMC伴有颈部LNM有关。

Objective To investigate the relationship of papillary thyroid inicrocarcinoma(PTMC)with serum thyroglobulin.Methods Data of 539 patients with papillary thyroid nodule(Wlcm)in Department of Thyroid and Breast Surgery of the Seco nd Hospital of Anhui Medical University and the Department of Oncology Surgery of Suzhou Municipal Hospital for thyroidectomy were retrospectively analyzed.All of the nodules were classified as TI-RADS 4b with ultrasound.According to the postoperative pathological results,patients were divided into PTMC group(experiment group)and benign tumor group(control group).The PTMC patients were also divided into lymph node metastasis group(experiment group)and no lymph node metastasis group(control group)based on the cervical lymph node metastasis.Then we analyzed the relationship between thyroid stimulating hormone(TSH).thyroglobulin antibody(TgAb),thyroid peroxidase antibody(TPOAb)and thyroglobulin(Tg)with PTMC and lymph node metastasis by SPSS.Results Age,TSH,Tg and TgAb were independent risk factors for PTMC,B:-0.020,0.192,0.026,0.008,95%Cl:0.962-0.998,1.045-1.404,1.015-1.038,1.003-1.014,both P<0.05.The relations between PTMC and TSH,Tg and TgAb were positive,while age was in negative correlation with PTMC.Meanwhile,age and thyroglobulin(Tg)were also independent risk factors for lymph node metastasis in PTMC patients,B:-0.025,0.014,95%CI:0.957-0.994,1.008-1.021,both P<0.05.Age was negatively correlated with lymph node metastasis and Tg was positively correlated with lymph node metastasis.Tg level higher than 26.520 ng/ml indicated that the nodule was PTMC(sensitivity:0.560,specificity:0.719),and Tg level higher than 36.695 ng/ml predicted lymph node metastasis in PTMC patients(sensitivity:0.532,specificity:0.788).Conclusion Tg is a sensitive serum index for identifying PTMC from benign thyroid nodule,and it is also related to lymph node metastasis in PTMC patients.