不同体质量指数的甲状腺结节及分化型甲状腺癌患者的临床特点分析

Clinical characteristics of patients with thyroid nodules and differentiated thyroid cancer with different body mass index

目的探讨体质量指数(BMI)与甲状腺结节发病率及分化型甲状腺癌(DTC)的临床特点、疗效评价之间的相关性。方法回顾性分析2016年4月至2020年7月间天津医科大学总医院的1375例健康体格检查(简称体检)者[男1031例、女344例,年龄(43.5±10.6)岁]和1450例中-高危DTC患者[男490例、女960例,年龄(44.3±12.4)岁]的临床资料,分别根据BMI分为体质量过低组(BMI<18.5 kg/m^(2))、体质量正常组(18.5≤BMI<24.0 kg/m^(2))、超体质量组(24.0≤BMI<28.0 kg/m^(2))和肥胖组(BMI≥28.0 kg/m^(2))。采用χ^(2)检验分析BMI与甲状腺结节发生间的关系及BMI与DTC的临床特点、疗效评价的关系。采用logistic回归分析甲状腺结节的发生及DTC侵袭性的危险因素。结果体检者中,结节组779例,无结节组596例。结节组较无结节组的超体质量及肥胖的占比更高[42.1%(328/779)和37.2%(222/596)、24.5%(191/779)和20.5%(122/596);χ^(2)=13.42,P=0.004],且年龄越大、促甲状腺激素(TSH)水平越低,患甲状腺结节的风险越高[比值比(OR):1.044和0.919,95%CI:1.029~1.060、0.845~0.999;P<0.001,P=0.046]。高风险结节者(4类及以上结节)较中等及以下风险结节(3类及其以下结节)者肥胖比例更高[5/15与24.3%(186/764);χ^(2)=21.11,P<0.001]。1450例DTC患者中,与体质量正常的患者(496例)相比,超体质量及肥胖组患者(563和361例)更易发生中央区淋巴结转移(OR值:1.418和1.427,95%CI:1.075~1.870、1.044~1.952;P值:0.013和0.026),肥胖组患者病灶为双侧的风险更大(OR=0.696,95%CI:0.519~0.934;P=0.016)。但BMI与疗效评价无明显关系(χ^(2)=9.13,P=0.425)。结论超体质量及肥胖人群的甲状腺结节发病率更高,DTC患者中超体质量及肥胖患者的侵袭性更强,但BMI与DTC患者治疗后疗效评价无关。

Objective To explore the association between body mass index(BMI)and the incidence of thyroid nodules,the clinical characteristics and efficacy evaluation of differentiated thyroid cancer(DTC),respectively.Methods Clinical data of 1375 healthy people(1031 males,344 females,age:(43.5±10.6)years)who underwent routine physical examination(PE)and 1450 patients(490 males,960 females,age:(44.3±12.4)years)with medium-high risk DTC in Tianjin Medical University General Hospital from April 2016 to July 2020 were analyzed retrospectively.PE and DTC patients were classified into underweight group(BMI<18.5 kg/m^(2)),normal weight group(18.5≤BMI<24.0 kg/m^(2)),overweight group(24.0≤BMI<28.0 kg/m^(2))and obesity group(BMI≥28.0 kg/m^(2))respectively.χ^(2) test was employed to analyze the relation between BMI and thyroid nodules(with/without),BMI and clinical characteristics and efficacy evaluation of DTC,respectively.Logistic regression analysis was used to analyze the independent risk factors for the occurrence of thyroid nodules and the aggressiveness of DTC.Results Among PE,there were 779 cases with nodules,and 596 cases without nodules.Comparing with those without nodules,more overweight and obese were found in PE cases with nodules(42.1%(328/779)vs 37.2%(222/596),24.5%(191/779)vs 20.5%(122/596);χ^(2)=13.42,P=0.004).Higher risk of developing thyroid nodules was related with older age and lower thyroid stimulating hormone(TSH)level(odds ratio(OR):1.044,0.919,95%CI:1.029-1.060,0.845-0.999;P<0.001,P=0.046).People with high-risk nodules were more likely to be obese than those with intermediate and lower risk nodules(5/15 vs 24.3%(186/764);χ^(2)=21.11,P<0.001).Among 1450 DTC patients,comparing with patients with normal weight,patients in the overweight and obesity groups were more likely to have central regional lymph node metastasis(OR:1.418,1.427,95%CI:1.075-1.870,1.044-1.952;P values:0.013,0.026),and patients in obese group were with greater risk of lesions being bilateral(OR=0.696,95%CI:0.519-0.934;P=0.016).BMI was not related with the efficacy evaluation of DTC(χ^(2)=9.13,P=0.425).Conclusions The incidence of thyroid nodules in people with high BMI is higher.DTC patients with high BMI may have more aggressive incidence.But BMI has no correlation with the efficacy evaluation of DTC patients after treatment.