不同性别人群外周血单核细胞与高密度脂蛋白胆固醇比与甲状腺乳头状癌的关联性研究

Association of Peripheral Blood Mononuclear Cell to HDL Cholesterol Ratio with Papillary Thyroid Carcinoma in Different Genders

背景甲状腺癌(TC)是内分泌系统最常见的恶性肿瘤,近年来其发病率增长迅速。甲状腺乳头状癌(PTC)是最常见的甲状腺癌类型,占所有TC的80%。尽管手术治疗、放射性碘治疗、促甲状腺激素(TSH)抑制治疗和新型靶向药物治疗取得一定疗效,但是早期诊断和干预才是阻止其发生、发展的关键,然而目前临床上PTC相关敏感性指标仍然缺乏。目的探讨脂代谢、炎症相关指标与PTC的相关性。方法选择2018年1月—2020年12月华北理工大学附属医院诊治的PTC患者作为病例组(n=370),根据病例组性别和年龄匹配同期体检健康人群为对照组(n=1112)。收集两组年龄、性别、吸烟情况、BMI、外周血白细胞计数(WBC)、血小板计数(PLT)、淋巴细胞计数(LYM)、单核细胞计数(MON)、中性粒细胞计数(NEU)、空腹血糖(FBG)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿素(UREA)、肌酐(Cr)、尿酸(UA),计算中性粒细胞与淋巴细胞比(NLR)、血小板与淋巴细胞比(PLR)、淋巴细胞与单核细胞比(LMR)、单核细胞与高密度脂蛋白胆固醇比(MHR),分析其与PTC的相关性及其诊断价值。结果与对照组比较,病例组患者外周血中WBC、LYM、MON、LDL-C、MHR均高于对照组(P<0.001)。不同性别PTC患者PLR、LYM、MHR比较,差异有统计学意义(P<0.05)。在相关性分析中,女性PTC患者MHR指标与肿瘤大小呈正相关(r=0.582,P<0.05);而男性PTC患者MHR与肿瘤大小的相关性较弱(r=0.355,P<0.05)。二元Logistic回归分析结果显示:在女性PTC患者中,PLR为保护因素(OR=0.475,P=0.004),LYM、MHR为危险因素[(OR=1.605,P=0.044)、(OR=2.659,P<0.001)];在男性患者中:PLR(OR=0.280,P=0.011)、MHR(OR=0.312,P=0.029)为保险因素。MHR在男女PTC患者中的AUC分别为0.548和0.652,提示MHR指标在女性PTC患者的诊断价值高于男性。结论MHR与PTC的发生相关联,在女性中是独立危险因素,在男性中是保护因素。

Background Thyroid cancer(TC)is the most common malignant tumor of the endocrine system,and its incidence has increased rapidly in recent years.Papillary thyroid cancer(PTC)is the most common type of thyroid cancer,accounting for 80% of all thyroid cancers.Despite the efficacy of surgical treatment,radioactive iodine therapy,TSH inhibition therapy and novel targeted drug therapy,early diagnosis and intervention are the key to stop its occurrence and development,however,the sensitivity indexes related to PTC are still lacking in clinical practice.Objective To investigate the correlation between lipid metabolism,inflammatory markers and sex of patients with PTC.Methods The data of PTC patients(n=370) diagnosed and treated in the Affiliated Hospital of North China University of Science and Technology from January 2018 to December 2020 were selected for retrospective analysis,and the normal population of physical examination in the same period was matched according to age and gender as the control group(n=1 112).Age,gender,smoking status,BMI,peripheral blood white blood cell count(WBC),platelet count(PLT),lymphocyte count(LYM),monocyte count(MON),neutrophil count(NEU),fasting blood glucose(FBG),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total cholesterol(TC),were collected in both groups,triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),urea(UREA),creatinine(Cr),and uric acid(UA),and calculate the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-monocyte ratio(LMR),and monocyte-to-HDL cholesterol ratio(MHR).Analyze the correlation between the above indicators and PTC and their diagnostic value.Results Compared with control group,WBC,LYM,MON,LDL-C and MHR in case group were higher than those in control group(P<0.001).There were significant differences in PLR,LYM and MHR between the two groups(P<0.05).In correlation analysis,there was a positive correlation between MHR indicators and tumor size in female PTC patients(r=0.582,P<0.05).The correlation between MHR and tumor size in male PTC patients is weak(r=0.355,P<0.05).Binary Logistic regression analysis showed that:in female patients with PTC(papillary thyroid carcinoma),PLR served as a protective factor(OR= 0.475,P=0.004),while LYM and MHR were identified as risk factors[for LYM:OR=1.605,P=0.044;for MHR:OR=2.659,P<0.001].Conversely,in male patients,PLR and MHR found to be protective factors[(OR= 0.280,P=0.011),(OR=0.312,P=0.029)].The AUC values for MHR in female and male PTC patients were 0.548 and 0.652,respectively,suggesting a higher diagnostic value of the MHR indicator in female PTC patients compared to their male counterparts.The AUC areas of MHR in male and female PTC patients were 0.548 and 0.652,respectively,indicating that the diagnostic value of MHR indicators in female PTC patients is higher than that in males.Conclusion MHR is associated with the occurrence of thyroid papillary carcinoma,and is an independent risk factor in women,while a protective factor in men.