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1、夕卜科雜志2014年12月第22卷第12期JClinSurg,December2014,Vo1.22,No.12·899··論著·術(shù)前血清促甲狀腺激素對甲狀腺乳頭狀癌頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移的影響董鴻李興睿劉謹(jǐn)文逯超易繼林[摘要】目的探討術(shù)前血清促甲狀腺激素(TSH)水平對甲狀腺乳頭狀癌側(cè)方淋巴結(jié)轉(zhuǎn)移的影響。方法回顧性收集2011年1月至2014年5月問首診收治以最終病理結(jié)果證實為甲狀腺乳頭狀癌且行頸側(cè)區(qū)淋巴結(jié)清掃的病例,閾值效應(yīng)分析、多元Logistic回歸分析等方法分析術(shù)前血清TSH對頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移的影響。結(jié)果共收
2、集157例甲狀腺乳頭狀癌病例,術(shù)前平均TSH為(2.48±1.91)~IU/ml,術(shù)前血清TSH與側(cè)方淋巴結(jié)轉(zhuǎn)移存在相關(guān)性,閾值效應(yīng)分析顯示兩者相互關(guān)系存在分段特征,在<1.475~IU/ml時,隨著TSH濃度的升高,頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移風(fēng)險升高,多因素Logistic回歸顯示該段TSH對頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移具有獨立作用。血清TSH濃度>1.475~IU/ml時,并無上述結(jié)果。結(jié)論術(shù)前血清TSH對甲狀腺乳頭狀癌頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移可能存在影響,不同濃度的血清TSH對頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移的影響不同,相關(guān)的機制尚不明確,宜進一步討論
3、。[關(guān)鍵詞]甲狀腺乳頭狀癌;促甲狀腺激素;頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移[中圖分類號]R653[文獻標(biāo)識碼]A[DOI]10.3969/j.issn.1005-6483.2014.12.008Effectofpreoperativeserumthyroidstimulatinghormoneonlaterallymphnodemetastasisinpa·pillarythyroidcarcinomaDONGHong,LI幾g—rui,LIUJin—wen,eta1.(DepartmentofBreastandThroidSu
4、rgery,TongfiHospital。TongfiMedicalCollege,HuazhongUniversityofScienceandTechnology,Wuhan430030,China)[Abstract]ObjectiveToinvestigatetheefectofpreoperativeserumthyroidstimulatinghormone(TSH)onlateralcervicallymphnodemetastasis(LCNM)inpapillarythyroidcarcinoma
5、.MethodsFromJanuary2011toMay2014,aretrospectiveanalysiswasperformedinpatientsadmittedinWuhanTon~iHospital,whowerediagnosedaspapillarythyroidcarcinomabypathologicalresultandreceiveddissectionoflateralcervicallymphnode.Thresholdeffectandmultivariatelogisticregr
6、essionwereaccomplishedtoanalyzetheeffectsofpreoperativeserumTSHonLCNM.ResultsAtotalof157patientswerereviewed.ThemeanpreoperativeTSHwas(2.48±1.91)IxlU/m1.TherewascorrelationbetweenpreoperativeserumTSHandLCNMinthesepatients,andathresholdefectwasnoticed.Inpatien
7、tswithTSHlessthan1.475~IU/ml。theriskofLCNMincreasedwiththeelevationofserumTSHconcentration.MuhivariatelogisticregressionconfirmedtheindependenteffectofTSHonLCNM.ButinotherpatientswithTSHgreaterthanorequalto1.475ixlU/ml。therewerenosimilarresults.ConclusionPreo
8、perativeserumTSHmayaffectLCNMandtheinfluenceiSnotthesamewhentheTSHconcentrationiSdifferent.FurtherdiscussioniSre.quiredforclarifyingthespecificmechanisms.[Keywords]papillarythyroidcarcino