桥本甲状腺炎并发分化型甲状腺癌的影响因素及甲状腺激素水平对其预测价值

Influencing factors of Hashimoto′s thyroiditis complicated with differentiated thyroid cancer and the predictive value of thyroid hormone levels

目的:探讨桥本甲状腺炎(HT)并发分化型甲状腺癌(DTC)的影响因素,并分析甲状腺激素水平预测HT并发DTC的价值。方法:收集齐齐哈尔医学院附属第一医院2018年1月至2021年2月HT并发DTC患者(n=120,HD组)、HT并发良性结节患者(n=150,对照组)。回顾两组一般资料及甲状腺B超、甲状腺激素、甲状腺自身免疫抗体[总甲状腺素(TT4)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、血清甲状腺球蛋白(Tg)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)]检查结果,应用Logistic回归模型分析HT并发DTC的影响因素,并绘制ROC曲线分析甲状腺激素预测HT并发DTC的价值。结果:与对照组比较,HD组低回声结节、结节边界模糊、A/T值≥1、微钙化均明显增多(P<0.05)。HD组TT4、FT4、TSH均高于对照组,TgAb低于对照组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,低回声结节、结节边界模糊、A/T值≥1、微钙化情况以及FT4、TSH、TgAb是HT并发DTC的危险因素(P<0.05)。ROC结果显示,FT4、TSH、TgAb三项指标联合AUC为0.983,当取最佳截断值时,其敏感度、特异度分别为93.3%、92.7%。结论:低回声、边界欠清、A/T值≥1、微钙化及FT4、TSH、TgAb均为HT并发DTC的危险因素,在早期筛查时应给予重点关注;而甲状腺激素FT4、TSH、TgAb三项联合预测价值高,可用于HT并发DTC早筛,以提高检出率。

Aim:To explore the influencing factors of Hashimoto'′s thyroiditis(HT)complicated with differentiated thyroid cancer(DTC),and to analyze the value of thyroid hormone levels in predicting HT complicated with DTC.Methods:A total of 120 patients with HT complicated with DTC from the First Affiliated Hospital of Qiqihar Medical University from January 2018 to February 2021 were collected and set as the HD group,and 150 patients with HT complicated with benign nodules were set as the control group.Review the general data of the two groups and the results of thyroid B-ultrasound,thyroid function,and thyroid autoimmune antibodies.Logistic regression model was used to analyze the influencing factors of HT complicated with DTC,and the receiver operating characteristic(ROC)curve was drawn to analyze the prediction value of thyroid hormones.Results:Compared with the control group,the HD group had more hypoechoic nodules,and nodules blurred boundaries with A/T value≥1,or microcalcification(P<0.05);the levels of TT4,FT4,TSH of HD group were significantly higher than those of control group,with TgAb as lower(P<0.05).Logistic regression analysis showed that hypoechoic nodules,fuzzy boundaries of nodules,A/T value≥1,microcalcification,FT4,TSH,and TgAb were all risk factors for HT with DTC(P<0.05).ROC results showed that the AUC of the three combined indicators of FT4,TSH,and TgAb was 0.983.When the best cut-off value was taken,the sensitivity and specificity were 93.3%and 92.7%,respectively.Conclusion:Hypoechoic,poor boundary,A/T value≥1,microcalcification,FT4,TSH,and TgAb are all risk factors for HT with DTC,and attention should be paid to early screening;while the combination of FT4 and TSH and TgAb has high predictive value,and can be used for early screening of HT with DTC.