甲状腺自身抗体水平与分化型甲状腺癌中央区淋巴结转移的相关性

目的:探讨甲状腺自身抗体［甲状腺球蛋白抗体（TGAb）、甲状腺过氧化物酶抗体（TPOAb）和促甲状腺激素受体抗体（TRAb）］增高是否会影响分化型甲状腺癌（DTC）的中央区（VI区）淋巴结转移率。方法:回顾性分析200例单中心收治的行甲状腺全切术+中央区淋巴结清扫术且病理证实为DTC患者的临床及病理资料，比较不同的自身抗体组合状态患者的临床病理特征的差异以及分析不同自身抗体组合状态是否是影响DTC患者中央区淋巴结阳性的独立危险因素。结果:共纳入200例DTC患者，年龄≤45岁80例，>45岁120例；男性67例，女性133例；TGAb阳性、TPOAb阳性、TRAb阴性者24例；TGAb阳性、TPOAb阳性、TRAb阳性者29例；TGAb阳性、TPOAb阴性、TRAb阴性者27例；TGAb阳性、TPOAb阴性、TRAb阳性者23例；TGAb阴性、TPOAb阳性、TRAb阴性者14例;TGAb阴性、TPOAb阳性、TRAb阳性者17例；TGAb阴性、TPOAb阴性、TRAb阴性者48例；TGAb阴性、TPOAb阴性、TRAb阳性者18例。发现自身抗体阳性状态更倾向于双侧肿瘤（P＜0.05）以及中央区淋巴结阳性（P＜0.001）DTC患者，但未发现这8种不同组合在年龄、性别、肿瘤大小、是否侵犯神经、血管、是否多灶性及术前TSH水平方面比较差异有统计学意义（P＞0.05）。本研究中央区淋巴结阳性者112例，阴性者88例，多因素分析结果发现肿瘤多灶性、双侧性、自身抗体均阳性组合状态（TGAb阳性、TPOAb阳性、TRAb阳性）以及术前TSH降低是影响中央区淋巴结转移的独立危险因素（P均＜0.05），未发现自身抗体其他组合状态及其他因素与中央区淋巴结转移有关（P＞0.05）。结论:DTC患者甲状腺自身抗体（TGAb、TPOAb、TRAb）均增高是影响中央区淋巴结阳性的高危因素，增加中央区淋巴结转移率，建议行预防性中央区淋巴结清扫。

Correlation between thyroid autoantibody level and central lymph node metastasis in differentiated thyroid carcinoma

Objective:To investigate whether the increase of thyroid autoantibodies
［thyroid globulin antibody (TGAb),thyroid peroxidase antibody (TPOAb) and TSH receptor antibody (TRAb)］ will affect the rate of lymph node metastasis in the central area (VI area) of differentiated thyroid carcinoma (DTC).Methods:The clinical and pathological data of 200 patients with DTC who underwent total thyroidectomy plus central lymph node dissection in a single center were analyzed retrospectively.The clinicopathologic characteristics of patients with different autoantibody combinations were compared,and whether different autoantibody combinations are the independent risk factors for positive central lymph node in DTC patients or not were analyzed.Results:Among the 200 DTC patients,80 were younger than 45 years old and 120 were more than 45 years old.There were 67 males and 133 females,24 patients were TGAb positive,TPOAb positive and TRAb negative,29 cases were TGAb positive,TPOAb positive and TRAb positive,27 cases were TGAb positive,TPOAb negative and TRAb negative,23 cases were TGAb positive,TPOAb negative and TRAb positive,14 cases were TGAb negative,TPOAb positive and TRAb negative,and 17 cases were TGAb negative,TPOAb positive and TRAb positive.TGAb negative,TPOAb negative,TRAb negative in 48 cases,TGAb negative,TPOAb negative,TRAb positive in 18 cases.It was found that there were significant differences in bilateral tumor (P＜0.05) and central lymph node positive (P＜0.001) in DTC patients with 8 different autoantibody combinations,but no significant differences were found in age,gender,tumor size,nerve invasion,blood vessel invasion,tumor multifocality and preoperative TSH level (P＞0.05).In this study,there were 112 cases of VI area positive and 88 cases negative.Multivariate analysis results showed that tumor multifocality,bilateral tumor,autoantibody positive combination status (TGAb positive,TPOAb positive,TRAb positive) and preoperative decrease of TSH were the independent risk factors for central lymph node metastasis (P＜0.05).No other combination of autoantibodies and other factors were found to be related to central lymph node metastasis (P＞0.05).Conclusion:The increase of thyroid autoantibodies (TGAb,TPOAb,TRAb) in patients with DTC is a high risk factor for positive lymph nodes in the central region,and the rate of lymph node metastasis in the central area is increased.Prophylactic central lymph node dissection is recommended.