桥本氏病合并甲状腺乳头状癌患者血清甲状腺相关激素水平的变化及意义

Changes and Significance of Serum Thyroid Related Hormones Levels in Patients with Hashimoto Thyroiditis Complicated with Papillary Thyroid Carcinoma

目的:探究桥本氏病(HT)合并甲状腺乳头状癌(PTC)患者血清甲状腺相关激素水平的变化及意义。方法:对我院148例HT患者的临床资料进行回顾性分析,根据其是否合并PTC分为HT合并PTC组(n=68)和单纯HT组(n=80)。比较两组患者性别、年龄及血清促甲状腺激素(TSH)、甲状腺功能指标[游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)]、抗甲状腺抗体[甲状腺球蛋白抗体(TGAb)、甲状腺过氧物酶抗体(TPOAb)]水平等临床资料差异,分析血清TSH水平变化及意义。结果:HT合并PTC组患者男性比例、年龄、病程及血清TSH水平均大于单纯HT组,血清TGAb、TPOAb水平则均小于单纯HT组(P<0.05);血清FT3、FT4水平比较差异无统计学意义(P>0.05)。HT合并PTC患者组血清TSH>4.2 m IU/L患者占比高于血清TSH正常组(P<0.05)。血清TSH>4.2 m IU/L患者中HT合并PTC患者的占比大于血清TSH水平正常的患者(P<0.05)。HT合并PTC患者中,血清TSH水平>4.2 m IU/L患者中央区淋巴结转移发生率高于血清TSH水平正常患者(P<0.05);血清TSH>4.2 m IU/L与血清TSH正常患者多灶癌发生率比较差异无统计学意义(P>0.05)。结论:HT患者血清TSH水平升高可能促进其甲状腺组织癌变,HT合并PTC患者血清TSH水平升高可能促进其中央区淋巴结转移。

Objective:To explore the changes and significance of serum thyroid hormones levels in patients with Hashimoto thyroiditis(HT)complicated with papillary thyroid carcinoma(PTC).Methods:The clinical data of 148 patients with HT in our hospital were retrospectively analyzed.According to whether they were complicated with PTC or not,they were divided into HT with PTC group(n=68)and simple HT group(n=80).The clinical data of gender,age,and levels of serum thyroid stimulating hormone(TSH),thyroid function indicators[free triiodothyronine(FT3),free thyroxine(FT4)]and anti-thyroid antibody[thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb)]were compared between the two groups.The changes and significance of serum TSH level were analyzed.Results:The proportion of male,age,disease duration and serum TSH level in HT with PTC group were higher than those in the simple HT group while the levels of TGAb and TPOAb were lower than those in simple HT group(P<0.05).There was no significant difference in the serum levels of FT3 and FT4(P>0.05).The proportion of patients with serum TSH>4.2 m IU/L in HT with PTC group was greater than that in normal serum TSH group(P<0.05).The proportion of patients with HT and PTC among patients with serum TSH>4.2 m IU/L was greater than that among patients with normal serum TSH(P<0.05).In HT patients with PTC,the incidence rate of lymph node metastasis in central area in patients with serum TSH level>4.2 m IU/L was higher than that in patients with normal serum TSH(P<0.05).There was no statistically significant difference in the incidence rate of multifocal cancer between patients with serum TSH>4.2 m IU/L and patients with normal serum TSH(P>0.05).Conclusions:Elevated serum TSH level in HT patients may promote thyroid tissue carcinogenesis,and increased serum TSH level in patients with HT and PTC may promote lymph node metastasis in central area.