桥本氏甲状腺炎合并多灶性甲状腺乳头状癌的超声及临床特征分析

Ultrasonographic and clinical characteristics of Hashimoto thyroiditis complicated by multifocal papillary thyroid carcinoma

目的研究桥本氏甲状腺炎(HT)合并多灶性甲状腺乳头状癌(mPTC)的临床及超声特征,探讨HT与mPTC之间的关系及可能的机制。方法回顾性分析2017年6月至2020年12月郑州大学第一附属医院收治的经病理证实为HT的508例患者的临床资料,其中单纯HT 96例,HT伴甲状腺乳头状癌(PTC)412例(单发PTC 285例,mPTC 127例)。分析性别、年龄、超声特征、术前血清甲状腺功能[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]、甲状腺过氧化物酶抗体(TPOAb)及BRAF基因状态与HT伴发mPTC的关系。结果HT伴PTC患者超声检查显示多表现为低回声实性结节、边界不清、形态不规则、纵横比>1、微钙化、异常肿大淋巴结等。HT伴PTC患者的平均年龄及TPOAb>500 IU/mL者比例低于单纯HT患者(P<0.05),TSH水平及TSH>5.6 IU/mL者比例高于单纯HT患者(P<0.05);HT伴PTC患者与单纯HT患者性别及FT3、FT4水平比较差异未见统计学意义(P>0.05)。HT伴mPTC患者中TPOAb>500 IU/mL者比例及BRAF基因突变率高于HT伴单发PTC患者(P<0.05),二者TSH增高者比例比较差异未见统计学意义(P>0.05)。结论HT患者血清高水平的TPOAb可能促进甲状腺组织癌变及mPTC的发生,高频彩色多普勒超声具有典型的超声特征,TSH的升高可能对HT发生多灶癌无明显影响。

ObjectiveTo study the ultrasonographie and chinical characteristics of Hashimoto thyroiditis(HT)complicated by multifocal papillary thyroid carcinoma(mPTC),and to investigate the relationship between HT and mPTC and the possible mechanisms.MethodsThe clinical data of 508 patients diagnosed with HT by pathology examination in the First Affiliated Hospital of Zhengzhou University from June 2017 to December 2020 were retrospectively analyzed;among them,96 cases had HT alone,and 412 cases had HT complicated by papillary thyroid carcinoma(PTC),including 285 cases of solitary PTC and 127 cases of mPTC.The correlations of gender,age,ultrasonographic characteristics,preoperative serum thyroid function assessed by free triiodothyronine(FT3),free thyroxine(FT4)and thyroid stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb)and BRAF gene status with mPTC complicated by HT were analyzed.ResultsUltrasonography of HT complicated by PTC showed hypoechoic solid nodules,unclear borders,irregular morphology,aspect ratios>1,microcalcifications,and abnormal enlargement of lymph nodes.Compared with patients with HT alone,patients with HT complicated by PTC had lower mean age,a lower proportion of patients with TPOAb>500 IU/mL,higher level of TSH and a higher proportion of patients with TSH>5.6 IU/mL(P<0.05).There was no statistically significant difference in gender,levels of FT3 and FT4 between patients with HT complicated by PTC and patients with HT alone(P>0.05).Compared with patients with HT complicated by solitary PTC,patients with HT complicated by mPTC had a higher proportion of patients with TPOAb>500 IU/mL and a higher BRAF gene mutation rate(P<0.05).There was no statistically significant difference in the proportion of individuals with increased TSH between patients with HT complicated by solitary PTC and patients with HT complicated by mPTC(P>0.05).ConclusionsThe high level of serum TPOAb in HT patients may promote development of thyroid tissue carcinoma and mPTC.High-frequency colour Doppler ultrasound of patients with HT complicated by mPTC has typical ultrasonographic characteristics;and elevated TSH may have no significant impact on development of multifocal carcinoma in patients with HT.