血清炎症因子、凝血指标与甲状腺癌临床病理特征及预后的相关性

Correlation between serum inflammatory factors and coagulation indicators with clinicalpathological characteristics and prognosis in thyroid cancer

目的 分析甲状腺癌患者病理组织学与血清炎症因子、凝血指标的相关性。方法 选择2016年3月至2017年12月陕西省肿瘤医院头颈科收治的甲状腺癌患者90例为甲状腺癌组,选择同期在该院体检的健康者(甲状腺超声评价分级1级)60例作为健康对照组,以及体检发现甲状腺结节者(甲状腺超声评价分级2~3级)56例作为甲状腺结节组。收集所有研究对象系统免疫炎症指数(SII)、趋化因子受体4(CXCR4)蛋白、肿瘤坏死因子-α(TNF-α)、高迁移率族蛋白B1(HMGB1)及凝血指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(Fbg)];分析不同临床病理特征甲状腺癌患者的血清炎症因子及凝血功能指标水平。采用Kaplan-Meier法计算患者无瘤生存期,对预后生存差异进行对数秩检验(Log-Rank)比较。结果 甲状腺结节组、甲状腺癌组患者SII、TT及血清HMGB1、TNF-α、CXCR4、Fbg水平均明显高于健康对照组(P<0.05)。甲状腺结节组、甲状腺癌组患者PT、APTT明显低于健康对照组(P<0.05)。滤泡癌、发生淋巴结转移、TNM分期Ⅲ+Ⅳ期的甲状腺癌患者SII及血清HMGB1、TNF-α、CXCR4水平均分别高于乳头状癌、未发生淋巴结转移、TNM分期Ⅰ+Ⅱ期的患者(P<0.05)。90例甲状腺癌患者随访5年,5年累计无瘤生存率为82.22%(74/90)。生存曲线显示,高水平SII、HMGB1、TNF-α、CXCR4、Fbg、TT的甲状腺癌患者无瘤生存率明显低于低水平SII、HMGB1、TNF-α、CXCR4、Fbg、TT患者(Log-Rank χ^(2)=6.842、8.899、6.857、12.051、6.687、8.342,P<0.05)。结论 甲状腺癌患者血清炎症因子、凝血指标与临床病理特征存在一定关系,检测血清炎症因子、凝血指标对诊断甲状腺癌及评估病情变化有一定帮助,并有助于评估甲状腺癌患者预后情况。

Objective To analyze the correlation between the pathological histology with serum inflammatory factors and coagulation indexes in the patients with thyroid cancer.Methods Ninety patients with thyroid cancer admitted and treated in the head and neck department of Shaanxi Provincial Tumor Hospital from March 2016 to December 2017 were selected as the thyroid cancer group,at the same time 60 cases healthy individuals(with the thyroid ultrasound evaluation in the hospital grade of 1)who underwent physical examination in thehospital were selected as the healthy control group,and 56 cases(with the thyroid ultrasound evaluation grade of 2-3)who were found to have thyroid nodules during physical examination were selected as the thyroid nodule group.The systemic immune inflammatory index(SII),chemokine receptor 4(CXCR4)protein,tumor necrosis factor-α(TNF-α),high mobility group protein B1(HMGB1)and coagulation indexes[activated partial thromboplastin time(ATPP),prothrombin time(PT),thrombin time(TT),fibrinogen(Fbg)]were collected from all the study subjects;The serum inflammatory factors,coagulation indexes levels with thyroid cancer with different clinical characteristics were analyzed;the Kaplan-Meier method was used to calculate the tumor-free survival of the patients,and the prognostic survival differences conducted the Log-Rank test comparison.Results The levels of serum SII,HMGB1,TNF-α,CXCR4,Fbg,and TT in the thyroid nodule group and thyroid cancer group were significantly higher than those in the healthy control group(P<0.05).Serum PT and APTT in the thyroid nodule group and thyroid cancer group were significantly lower than those in the healthy control group(P<0.05).Serum SII,HMGB1,TNF-αand CXCR4 levels in the patients with follicular carcinoma,lymph node metastasis and TNM stageⅢ+Ⅳwere higher than those in the patients with the papillary carcinoma,lymph node non-metastasis and TNM stageⅠ+Ⅱ,respectively(P<0.05).Ninety patients with thyroid cancer were followed up for 5 years,and the 5-year cumulative tumor-free survival rate was 82.22%(74/90).The survival curve showed that the tumor-free survival rates in the patients with high levels of SII,HMGB1,TNF-α,CXCR4,Fbg and TT were significantly lower than those in the thyroid cancer patients with low levels of SII,HMGB1,TNF-α,CXCR4,Fbg and TT(Log-Rankχ^(2)=6.842,8.899,6.857,12.051,6.687,8.342,P<0.05).Conclusion There is a certain relationship between serum inflammatory factors and coagulation indexes with clinicopathological characteristics in the patients with thyroid cancer.Detecting the expression levels of serum inflammatory factors and coagulation indexes is helpful in the diagnosis of thyroid cancer and assessment of disease condition change,and helps to assess the prognosis of the patients with thyroid cancer.