2025 年第 10 期 第 20 卷

甲状腺激素敏感性指标对老年分化型甲状腺癌术后复发转移的预测价值

The predictive value of thyroid hormone sensitivity indicators for postoperative recurrence and metastasis of differentiated thyroid cancer in the elderly

作者：王苹1姚文娟2王丹1史丽英3

英文作者：Wang Ping1 Yao Wenjuan2 Wang Dan1 Shi Liying3

单位：1北京大学第一医院太原医院山西省太原市中心医院内分泌科，太原030009；2武警山西总队医院重症医学科，太原030006；3北京大学第一医院太原医院山西省太原市中心医院全科医学科，太原030009

英文单位：1Department of Endocrinology Peking University First Hospital Taiyuan Hospital Taiyuan Central Hospital Shanxi Province Taiyuan 030009 China; 2Department of Intensive Care Medicine Shanxi Armed Police Force Hospital Taiyuan 030006 China; 3Department of General Medicine Peking University First Hospital Taiyuan Hospital Taiyuan Central Hospital Shanxi Province Taiyuan 030009 China

关键词：分化型甲状腺癌；甲状腺激素敏感性指标；复发；转移

英文关键词：Differentiatedthyroidcancer;Thyroidhormonesensitivityindicators;Recurrence;Metastasis

• 摘要：

• 目的 探讨甲状腺激素敏感性指标对老年分化型甲状腺癌（DTC）术后复发转移的预测价值。方法 回顾性选取北京大学第一医院太原医院2019年6月至2020年4月收治的老年DTC术后患者106例。依据患者术后3年是否发生复发转移分为有复发转移组（观察组， 19例）和无复发转移组（对照组，87例）。采用Logistic回归模型分析影响因素，采用受试者工作特征（ROC）曲线分析甲状腺激素敏感性指标对老年DTC患者术后复发转移的预测价值。结果 2组TNM分期、术后131I治疗、手术方法、术后应用促甲状腺激素（TSH）治疗比例及游离三碘甲状腺原氨酸、TSH、促甲状腺激素指数（TSHI）、促甲状腺素甲状腺素抵抗指数（TT4RI）、甲状腺反馈Quantile-based指数（TFQI）水平比较，差异均有统计学意义（均P<0.05）。二元Logistic回归分析，结果显示Ⅲ～Ⅳ期、TSH、TSHI、TT4RI、TFQI、术后131I治疗、甲状腺全切术、术后未应用TSH治疗均为老年DTC患者术后复发转移的危险因素（均P<0.05）。ROC曲线分析结果显示，甲状腺激素敏感性指标TSHI、TT4RI、TFQI联合预测DTC患者术后复发转移的曲线下面积为0.977（95%置信区间：0.937～0.999）。结论 甲状腺激素敏感性指标TSHI、TT4RI、TFQI联合预测老年DTC患者术后复发转移具有很高的准确性和预测价值，可作为临床预测老年DTC患者术后复发转移的有效指标。

• Objective To explore the predictive value of thyroid hormone sensitivity indicators for postoperative recurrence and metastasis of differentiated thyroid cancer (DTC) in the elderly. Methods A total of 106 elderly patients with DTC after surgery admitted to Peking University First Hospital Taiyuan Hospital from June 2019 to April 2020 were retrospectively selected. The patients were divided into recurrence and metastasis group (observation group, 19 cases) and non-recurrence and metastasis group (control group, 87 cases) according to whether recurrence and metastasis occurred 3 years after operation. Logistic regression model was used to analyze the influencing factors, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of thyroid hormone sensitivity indicators for postoperative recurrence and metastasis in elderly DTC patients. Results There were significant differences in TNM staging, postoperative 131I treatment, surgical methods , the proportion of postoperative thyroid-stimulating hormone (TSH) therapy, the levels of free triiodothyronine, TSH, thyroid stimulating hormone index (TSHI), thyroid-stimulating hormone resistance index (TT4RI), and thyroid feedback Quantile-based index (TFQI) between the two groups (all P<0.05). Binary Logistic regression analysis showed that stage Ⅲ-Ⅳ, TSH, TSHI, TT4RI, TFQI, postoperative 131I treatment, total thyroidectomy, and no postoperative TSH therapy were risk factors for postoperative recurrence and metastasis in elderly DTC patients (all P<0.05). ROC curve analysis showed that the area under the curve of thyroid hormone sensitivity indicators TSHI, TT4RI and TFQI combined to predict postoperative recurrence and metastasis of DTC patients was 0.977 (95% confidence interval: 0.937-0.999). Conclusions The combination of thyroid hormone sensitivity indicators TSHI, TT4RI and TFQI has high accuracy and predictive value in predicting postoperative recurrence and metastasis in elderly DTC patients, which can be used as effective indicators for clinical prediction of postoperative recurrence and metastasis in elderly DTC patients.