促甲状腺激素及甲状腺自身抗体与分化型甲状腺癌的关系研究

·论著·促甲状腺激素及甲状腺自身抗体与分化型甲状腺癌的关系研究黄婷，李卫星，张丽作者单位：830063新疆乌鲁木齐市，新疆医科大学第二附属医院内分泌科通讯作者：张丽，830063新疆乌鲁木齐市，新疆医科大学第二附属医院内分泌科；E －mail ：xingli0707@【摘要】目的探讨促甲状腺激素(TSH )及甲状腺自身抗体预测分化型甲状腺癌(DTC )的可行性及临床价值。

方法选取2009年1月—2011年12月在我院首次行手术治疗的甲状腺结节患者400例，术后病理学明确诊断为DTC 200例(DTC 组)和良性甲状腺结节200例(良性甲状腺结节组)。

检测两组患者术前血清TSH 、甲状腺球蛋白抗体(TgAb )、甲状腺过氧化物酶抗体(TPOAb )水平，根据TSH 参考范围分为降低、正常、升高;根据TgAb 参考范围分为阴性和阳性，分别进行统计学分析。

结果DTC 组血清TSH 水平为2.95(2.22)mU /L ，较良性甲状腺结节组的1.92(1.68)mU /L 升高(Z =－6.52，P ＜0.01);DTC 组患者TSH 升高40例、正常155例、降低5例，良性甲状腺结节组患者TSH 升高17例、正常170例、降低13例，两组患者TSH 水平分布情况比较，差异有统计学意义(u =－3.673，P ＜0.001)。

DTC 组血清TgAb 水平为154(48)mU /L ，较良性甲状腺结节组的35(14)mU /L 升高(Z =－2.35，P =0.019);DTC 组患者TgAb 阳性34例(17.0%)、阴性166例(73.0%)，良性甲状腺结节组患者TgAb 阳性9例(4.5%)、阴性191例(95.5%)，两组TgAb 阳性率比较，差异有统计学意义(χ2=18.56，P ＜0.01)。

DTC组血清TPOAb 水平为51(17)mU /L ，与良性甲状腺结节组的33(13)mU /L 比较，差异无统计学意义(Z =－0.916，P ＞0.05)。

单因素分析结果显示，TgAb 阳性〔β=1.49，OＲ=4.46，P ＜0.01，95%CI (2.15，9.23)〕、TSH 升高〔β=0.95，OＲ=2.58，P ＜0.01，95%CI (1.41，4.74)〕与DTC 相关。

多因素Logistic 回归分析结果显示，血清TgAb 阳性〔β=1.92，OＲ=6.82，P ＜0.01，95%CI (2.96，15.73)〕、TSH 升高〔β=0.88，OＲ=2.42，P ＜0.01，95%CI (1.24，4.72)〕进入回归模型。

DTC 伴颈部淋巴结转移组TSH 水平为2.95(2.22)mU /L ，较无颈部淋巴结转移组的2.66(1.98)mU /L 升高(Z =－6.11，P ＜0.01)。

结论术前血清中TSH 、TgAb 水平增高可能是DTC 的危险因素，二者是否可作为DTC 筛查的预测指标尚需大样本前瞻性试验研究证实。

血清TSH 水平升高与DTC 伴颈淋巴结转移相关。

【关键词】甲状腺肿瘤;甲状腺结节;促甲状腺素;甲状腺球蛋白抗体;甲状腺过氧化物酶抗体【中图分类号】Ｒ736.1【文献标识码】Adoi ：10.3969/j.issn.1007－9572.2013.12.074黄婷，李卫星，张丽.促甲状腺激素及甲状腺自身抗体与分化型甲状腺癌的关系研究［J ］.中国全科医学，2013，16(12):4258－4261.［ ］Ｒelationship between Differentiated Thyroid Cancer and Serum Thyroid Stimulating Hormone ，Thyroid Autoantibodies HUANG Ting ，LI Wei －xing ，ZHANG Li .Department of Endocrinology ，the Second Affiliated Hospital of Xinjiang Medical Uni-versity ，Urumqi 830063，China【Abstract 】ObjectiveTo investigate the feasibility and clinical value of thyroid stimulating hormone （TSH ），thyroidperoxidase antibody （TPOAb ）and thyroglobulin antibody （TgAb ）in predicting differentiated thyroid cancer （DTC ）．Methods From January 2009to December 2011，400patients with thyroid nodule underwent their first thyroidectomy ，200cases were diagnosed with DTC ，and the other 200cases were diagnosed with benign nodule by postoperative pathology.The levels of preop-erative serum TSH ，TgAb and TPOAb in patient of both groups were tested ，the patients were divided into negative group and positive group by the reference range of TgAb ；at the same time the patients were divided into three groups （low ，normal ，high ）according to reference range of TSH.The data were analyzed separately using method of statistics.ＲesultsPreoperative serumTSH level in DTC group and benign group was 2.95（2.22）mU /ml and 1.92（1.68）mU /ml ，separately ，TSH level in DTC group was significantly higher than that in benign group ，the difference was statistically significant （Z =－6.52，P ＜0.01）．Among DTC group ，the TSH level in 40cases was high ，the TSH level in 155cases was normal ，and the TSH level in 5cases was low ；Among benign group ，the TSH level in 17cases was high ，the TSH level in 170cases was normal ，the TSH level in 13cases was low.There was significant difference in TSH level distribution between DTC group and benign group （u =－3.673，P·8524·＜0.001）.Preoperative serum TgAb level in DTC group and benign group was154（48）mU/L and35（14）mU/L，sepa-rately，TgAb level in DTC group was significantly higher than that in benign group（Z=－2.35，P=0.019）.Among DTC group，TgAb in34cases was positive（17.0%），TgAb in166cases was negative（73.0%）；Among benign group，TgAb in 9cases was positive（4.5%），TgAb in191cases was negative（95.5%）.There was significant difference in TgAb positive rate between DTC group and benign group（χ2=18.56，P＜0.01）.Preoperative serum TPOAb level in DTC group and benign group was51（17）mU/L and33（13）mU/L in benign group，separately，there was no significant difference in TPOAb level between DTC group and benign group（Z=－0.916，P＞0.05）.Single factor analysis showed that both positive of TgAb〔β= 1.49，OＲ=4.46，P＜0.01，95%CI（2.15，9.23）〕and elevation of TSH〔β=0.95，OＲ=2.58，P＜0.01，95%CI （1.41，4.74）〕were correlated to DTC.In the multivariate Logistic regression analysis，positive of TgAb〔β=1.92，OＲ= 6.82，P＜0.01，95%CI（2.96，15.73）〕and elevation of TSH〔β=0.88，OＲ=2.42，P＜0.01，95%CI（1.24，4.72）〕entered the regression model.Level of serum TSH in DTC patients with neck lymph node metastasis and DTC patients without neck lymph node metastasis was2.95（2.22）mU/L and2.66（1.98）mU/L，separately，TSH level in DTC with metastasis group was significantly higher than that in simple DTC group（Z=－6.11，P＜0.01）.Conclusion Preoperative elevated serum TSH and TgAb levels may be the risk factors for DTC，large sample prospective studies are needed to confirm whether they can be used as predictors in DTC screening.The elevated serum TSH level is correlated to DTC with neck lymph node metastasis.【Key words】Thyroid neoplasms；Thyroid nodule；Thyrotropin；Thyroglobulin antibody；Thyroid peroxidase antibody甲状腺结节是内分泌系统常见的病症，流行病学调查显示一般人群甲状腺可触及结节的检出率约5%，随着超声检查的普及，甲状腺结节在人群中的检出率逐年上升，可高达67%，其中恶性占5% 10%［1］。