2017 年第 10 期 第 12 卷

术前促甲状腺激素水平与乳头状甲状腺癌的关系

Relation between preoperative thyroid stimulating hormone and papillary thyroid carcinoma

作者：哈力木拉提·木尔提扎其阿米西·别孜尔见宝尔江·阿斯哈尔王护国

英文作者：Halimulati Muertizha Qi′amixi Biezierjian Baoerjiang Asihaer Wang Huguo

单位：830054乌鲁木齐，新疆医科大学第一附属医院血管甲状腺外科

英文单位：Department of Vascular-Thyroid Surgery the First Affiliated Hospital of Xinjiang Medical University Urumqi 830054 China

关键词：甲状腺肿瘤；甲状腺肿,结节性；促甲状腺素

英文关键词：Thyroidneoplasms;Goiter,nodular;Thyrotropin

• 摘要：

• 目的 探讨术前促甲状腺激素(TSH)水平与乳头状甲状腺癌（PTC）的关系。方法 收集2011年1月至2016年12月于新疆医科大学第一附属医院首次行甲状腺切除术的1 231例患者的病历资料进行回顾性分析。依据术后病理检查结果及病灶大小分为微小癌组（403例）、非微小癌组（226例）和良性组（602例）。比较3组患者术前TSH水平，分析术前TSH水平与PTC临床病理学特征及其发生发展的关系。结果 3组患者术前TSH水平比较差异有统计学意义（Z=54.70, P<0.001），微小癌组及非微小癌组高于良性组［2.42(1.58,3.68)、2.49(1.58,3.81)mU/L比1.79(0.99,2.92)mU/L］，差异均有统计学意义（均P<0.05），且微小癌组、非微小癌组高水平TSH患者所占比例高于低水平TSH患者。有淋巴结转移患者（169例）与无淋巴结转移患者（460例）术前TSH水平差异无统计学意义（t=-0.253, P=0.800）。多因素Logistic回归分析结果显示，术前TSH水平在1.45～2.19 mU/L是PTC发生的独立危险因素(比值比=3.397，95%置信区间：2.015～5.727，P<0.001)。结论 术前TSH水平增高可能与PTC的发生有相关性，为PTC发生的危险因素之一。

• Objective To explore the relation between preoperative thyroid stimulating hormone（TSH） and papillary thyroid carcinoma（PTC）. Methods Clinical data of 1 231 patients who had thyroidectomy for the first time from January 2011 to December 2016 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. According to postoperative pathological findings and size of lesion, they were divided into minimum cancer group（403 cases）, non-minimum cancer group（226 cases） and benign group（602 cases）. Relations of preoperative TSH level with clinical pathological features, occurrence and development of PTC were analyzed. Results The preoperative TSH level had a significant difference among 3 groups（Z＝54.70, P＜0.001）; TSH in minimum cancer group and non-minimum cancer group was significantly higher than that in benign group［2.42（1.58,3.68）, 2.49（1.58,3.81）mU/L vs 1.79（0.99,2.92）mU/L］（P＜0.05）. The preoperative TSH level had no significant difference between patients with lymphatic metastasis（169 cases） and patients without lymphatic metastasis（460 cases）（t＝-0.253, P＝0.800）. Multivariate logistic regression analysis showed that preoperative TSH level ranging from 1.45 to 2.19 mU/L was an independent risk factor of PTC（odds ratio＝3.397, 95% confidence interval: 2.015-5.727, P＜0.001）. Conclusion Elevation of preoperative TSH level is a risk factor of occurrence of PTC.