【摘要】 目的探讨术前血清促甲状腺激素(TSH)水平与分化型甲状腺癌(DTC)发病的关系。方法回顾分析2011年6月～2016年5月上海交通大学附属第一人民医院耳鼻咽喉头颈外科收治的1 434例甲状腺结节患者的血清TSH水平、性别、年龄、肿瘤直径、有无淋巴结转移,探讨其与DTC发生之间的关系。结果术后病理确诊甲状腺良性结节(BTN,包括结节性甲状腺肿、甲状腺腺瘤等)915例,分化型甲状腺癌(乳头状癌、滤泡状癌)519例。男性426例,其中DTC 152例、BTN 274例;女性1 008例,其中DTC 367例、BTN 641例,2组间甲状腺癌的发病率差异无统计学意义(P=0.79)。DTC患者的平均年龄为(46.925±13.980)岁,小于BTN患者的平均年龄(53.936±11.956)岁,差异有统计学意义(P<0.05)。DTC患者术前血清TSH平均水平(2.488 5±1.577 2)μIU/mL与BTN患者(2.458 6±2.694 7)μIU/mL相比,差异无统计学意义(P=0.79),但随着TSH水平(即使在参考值范围内)的升高,甲状腺癌所占的比例也升高,差异有统计学意义(P<0.05)。DTC患者中颈淋巴结转移阳性组、阴性组和BTN组,术前TSH水平在三者之间无明显差异(P=0.82)。DTC患者中肿瘤直径≤10 mm、>10 mm和BTN组,3组间术前TSH水平无明显差异(P=0.68)。Logistic回归分析显示,DTC的发生与年龄呈负相关(OR=0.673,P<0.05),而与性别、TSH水平无相关性。结论血清TSH水平高、低龄、女性可能是预测分化型甲状腺癌风险的指标。TSH可能与甲状腺癌的发生有关,而与其发展无关。更多还原

【Abstract】 Objective To investigate the association between preoperative serum thyroid stimulating hormone(TSH) level and differentiated thyroid carcinoma(DTC). Methods One thousand four hundred and thirty-four patients with thyroid tumors who had undergone surgery at Shanghai Jiao Tong University Affiliated the First People′s Hospital between Jun. 2011 to May 2016 were included in this study. The data of serum TSH level, gender, age, tumor diameter, and lymphatic metastasis were retrospectively analyzed, and their associations with thyroid carcinoma incidence were explored. Results Nine hundred and fifteen cases of benign thyroid nodules(including nodular goiter and thyroid adenoma) were diagnosed and 519 cases of differentiated thyroid carcinoma(including papillary and follicular carcinoma) were diagnosed by pathology. There were 426 cases of male patients, including 152 cases of DTC and 274 cases of BTN, and 1 008 female patients, including 367 cases of DTC and 641 cases of BTN. There was no statistically significant difference in the incidence of thyroid cancer among the two groups(P=0.79). The average age of DTC patients was(46.925±13.980) years, which was less than that of BTN patients [(53.936±11.956) years](P<0.05). There was no difference between DTC patients [(2.488 5±1.577 2) μIU/mL] and BTN patients [(2.458 6±2.694 7) μIU/mL] before operation(P=0.79)in TSH lever, but the proportion of thyroid cancer increased with the increase of TSH level(even within reference range), and the difference was statistically significant(P<0.05). There was no difference in the preoperative TSH level among the cervical lymph node metastasis positive group, the negative group and the BTN group(P=0.82). There was no difference in preoperative TSH level among DTC patients with tumor diameter ≤10 mm, >10 mm and BTN patients(P=0.68). Logistic regression analysis showed that the occurrence of DTC was negatively correlated with age(OR=0.673, P<0.05), but had no correlation with sex(OR=1.051, P=0.699 2) or TSH level(OR=1.115, P=0.056 4). Conclusions High serum TSH levels, low age and female may be the indicators of predicting the risk of differentiated thyroid cancer. TSH may be related to the occurrence of thyroid cancer, but has nothing to do with its development.更多还原