女性分化型甲状腺癌临床及病理特点分析

  目的   分析女性分化型甲状腺癌的临床及病理特点。   方法   回顾性分析云南省第一人民医院2003年1月至2012年12月云南地区1 034例女性分化型甲状腺癌（differentiated thyroid carcinoma，DTC）及良性结节患者病历资料，进行单因素和多因素条件Logistic回归分析。   结果   女性DTC患者的平均年龄低于良性结节组。经单因素分析，女性DTC患者的术前血清TSH浓度高于良性结节组；DTC组TGAb、TRAb和TPOAb阳性率显著高于良性结节组；DTC组合并桥本氏甲状腺炎及淋巴细胞性甲状腺炎显著高于良性结节组；DTC组初潮年龄≤13岁、孕育子女数≤2个及未绝经的比率明显高于良性结节组。经多因素分析，年龄 < 45岁（OR=0.060，P < 0.001）、结节直径 < 1 cm（OR=0.377，P=0.006）和TG升高（OR=0.431，P=0.009）是女性DTC的保护性因素；TGAb（OR=4.949，P < 0.001）和TRAb（OR=23.001，P < 0.001）的异常升高是其独立危险因素。   结论   女性DTC发病年龄早于良性组；甲状腺术前血清TSH的异常升高、合并HT、月经初潮早、绝经晚及孕育子女数少与女性DTC的发生有一定关联；TGAb和TRAb的异常升高是女性DTC的独立危险因素；年龄 < 45岁、结节直径 < 1cm和TG升高是其保护性因素。  

Analysis of the clinicopathological characteristics of differentiated thyroid carcinoma in women

  Objective   We aimed to analyze the clinicopathological characteristics of differentiated thyroid carcinoma (DTC) in women.   Methods   The clinical data of 1, 034 female patients with thyroid nodules between January 2003 and December 2012 were retrospectively analyzed. These patients were from Yunnan Province, China. A database was established in Excel. Univariate and multivariate conditional logistic regression analyses were conducted by using SPSS 17.0.   Results   Female patients with DTC were younger than those with thyroid nodule disease or benign thyroid disease (BTD). The results of univariate conditional logistic regression analysis showed that the preoperative mean level of serum thyrotropin was higher in patients with DTC than in patients with BTD (P=0.034). The positive ratios of thyroid peroxidase antibody, thyroglobulin antibody (TGAb), and thyrotrophin receptor antibody (TRAb) were higher in patients with DTC than in patients with BTD (P < 0.001). The positive ratio of the coexistence of DTC with Hashimoto's thyroiditis (HT; 13.3%) or with lymphocytic thyroiditis (LT; 4.2%) was higher in patients with DTC than in patients with BTD and HT/LT (P < 0.001). The ratio of the patients whose age of menarche was ≤13 years, with ≤2 of births, or were in pre-menopausal condition in the DTC group was higher than that in the BTD group. The results of multivariate conditional logistic regression analysis showed that age < 45 years, nodal size < 1 cm, and thyroglobulin increase were protective factors of DTC with odds ratios (ORs) of 0.06, 0.377, and 0.431, respectively. An abnormal increase in TGAb and TRAb was an independent risk factor of female patients with DTC with ORs of 4.949 and 23.001, respectively.   Conclusion   Female patients aged 35 years to 44 years and with thyroid nodules were included in a high-risk group of DTC. Serous thyroid-stimulating hormone 1evel and coexistence with HT were positively correlated with the risk of DTC in females. Early menarche, late menopause, and low number of births were associated with the incidence of DTC in females. Age < 45 years, nodal diameter < 1 cm, and increase in thyroglobulin were protective factors of DTC in female. An abnormal increase in TGAb and TRAb was an independent risk factor of female DTC.