心理社会危险因素与大肠癌的相关性研究

目的 探讨个性行为特征、情绪状态和生活事件等心理社会因素与大肠癌发生的相关性,为更有效的防治大肠癌提供科学依据。方法 采用以医院为基础的病例-对照研究,病例组256人和对照组488人采用团体用心理社会应激调查表对其生活事件、情绪反应及应对方式三方面进行测评。结果 多因素Logistic回归结果显示人际关系不协调(OR=32.245)、子女前途问题(OR=3.773)、个人健康状况变化(OR=1.655)、着急(OR=1.894)、遇事压到心底(OR=3.300)和苦恼时喜欢一个人独处(OR=1.928)是大肠癌的危险因素。而心情愉快(OR=0.310)和遇事换个环境排解(OR=0.194)为大肠癌的保护性因素。结论 某些负性生活事件、消极的情绪及应对方式均与大肠癌的发病有关,而常保持心情愉快与遇事乐观态度会降低大肠癌的发病几率。     

甲状腺癌相关危险因素分析

[目的]分析甲状腺癌患者的临床及病理学特点,并探讨甲状腺癌的相关危险因素.[方法]收集行初次手术切除的316例甲状腺癌患者纳入病例组,按性别、年龄、籍贯等因素匹配后,以同期住院的非甲状腺癌患者作为对照组,收集两组患者的临床病理、生活方式、家族史等资料,采用多因素Logistic回归模型分析甲状腺癌的危险因素.[结果]不同性别的甲状腺癌病例类型分布比较差异无统计学意义(P=0.306).男性甲状腺癌患者的平均发病年龄低于女性患者(44.4±8.8岁vs.46.9±9.4岁,P=0.047),男、女患者的发病年龄高峰均为30～59岁.多因素Logistic回归分析显示:甲状腺疾病家族史(OR=7.156)、肿瘤家族史(OR=8.917)、BMI增高(OR=2.221)、经常性摄入海产品(≥3次/周)(OR=3.377)、甲状腺自身抗体增高(OR=2.904)是甲状腺癌的独立危险因素.[结论]女性甲状腺癌的发病率高于男性,发病高发年龄为30～59岁;甲状腺疾病家族史、肿瘤家族史、BMI增高、经常性摄入海产品(≥3次/周)、甲状腺自身抗体增高是甲状腺癌的独立危险因素.     

乳腺癌患者生活事件及社会支持和应对方式的调查

[目的]研究生活事件,特质应对方式,社会支持与乳腺癌发病风险之间的的关系。[方法]采用1∶1病例对照配对研究。400名女性患者作为病例组,400名健康女性作为对照组。由调查者与研究对象进行一对一的面谈,要求研究对象回忆被确诊前5年以来的应激性生活事件和自己的应对措施及主观感受。随后由其独立填写生活事件量表（LES）,特质应对方式问卷（TCSQ）和社会支持评定量表（SSRS）。[结果]两组在负性事件、社会生活事件总分、家庭问题、工作和学习问题,特质应对方式和社会支持上差异均有统计学意义（P〈0.0001）。而在正性事件、社会和其它问题得分无统计学意义（P=0.6544和P=0.98）。主观支持和社会支持总分为乳腺癌发病的保护因素（主观支持OR=0.697,95%CI：0.576～0.844,P=0.0002;社会支持总分OR=0.655,95%CI：0.560～0.765,P〈0.0001）。负性应对和负性事件为乳腺癌发病的危险因素（负性应对OR=1.149,95%CI：1.103～1.197;负性事件OR=1.051,95%CI：1.034～1.067;P〈0.0001）。[结论]减少负性生活事件、降低消极应对情绪、增加社会支持以拮抗生活事件中的负面影响是降低乳腺癌发病风险必不可少的重要因素。     

行政管理人员癌症发病社会心理危险因素研究

[目的]探讨与行政管理人员癌症发病有关的社会心理因素,为从社会心理预防打下基础.[方法]应用1:1配对研究方法,将136例经病理确诊的恶性肿瘤行政管理人员住院患者为病例组,与之配对的健康行政管理人员作为对照组.用标准问卷表分别对两组对象的生活事件、社会支持和防御机制进行调查,以癌症发病与否为应变量,用Logistic回归分析以上因素对癌症发病的影响.[结果]对一般的社会心理因素,经筛选后,用多元1:1条件Logistic回归分析显示:负性事件(OR=1.393,95%CI=1.110～1.748)、掩饰因子(OR=1.014,95%CI=1.004～1.024)、不好运动(OR=1.745,95%CI=1.205～2.528)、自己认为性格内向(OR=1.767,95%CI=1.063～2.935)等因素为行政管理人员癌症发病的社会心理因素.[结论]社会心理因素与行政管理人员癌症发病可能有关,应注意对负性事件和掩饰因子等危险因素进行防范.     

社会心理因素与癌症发病关系的研究

[目的]探讨与癌症发病有关的社会心理因素,为癌症的社会心理预防提供理论依据。[方法]应用1∶1配对研究方法。501例经病理确诊,卡氏评分≥60分的恶性肿瘤住院患者为病例组,根据1∶1配对原则,即与病例组相同性别、民族、职业、居住地、年龄相差±3岁、无身心疾患的健康人作为对照组。使用杨德森、张亚宁编制的“生活事件量表(LES)”、肖水源编制的“社会支持评定量表”和Bond编制的“防御方式问卷(DSQ)”分别对两组的生活事件、社会支持和防御机制进行问卷调查。[结果]病例组生活事件中的总事件、负性事件、家庭有关问题的评分较对照组高(P<0.05),病例组中的社会支持总分、客观支持分和对支持的利用度的评分比对照组低(P<0.05),两组防御方式评分比较,病例组的掩饰度比对照组高(P<0.05)。不成熟因子(OR=1.295,95％CI1.079～1.555)、掩饰因子(OR=0.762,95％CI0.655～0.887)、负性事件(OR=1.008,95％CI1.004～1.011)等社会心理因素进入癌症发病的1∶1配对的多元Logistic模型。[结论]社会心理因素与癌症发病有关,不成熟因子、掩饰因子和负性事件等为危险因素。     

内科住院患者良恶性甲状腺结节检出情况及发病相关影响因素分析

目的：了解内科住院患者甲状腺良恶性结节检出情况、分布特征及发病相关影响因素。方法：回顾性选择2013年1月至2017年12月重庆市第六人民医院内科住院患者1058例作为研究对象,对甲状腺超声检查及相关临床资料汇总分析,计算甲状腺结节和甲状腺癌的检出率,分析内科住院患者甲状腺结节发病的影响因素。结果：甲状腺结节阳性检出率为58.41%、甲状腺癌的检出率为1.51%。男性检出率明显低于女性(52.46% vs 64.83%; χ2=16.648, P<0.001);而不同性别住院患者甲状腺癌的检出率之间差异无统计学意义(1.46% vs 1.57%; χ2=0.023, P=0.897)。<40岁、40~49岁、50~59岁、60~69岁、70~79岁、≥80岁6个年龄段甲状腺结节检出率分别为37.93%、45.98%、61.92%、66.17%、68.99%、69.14%,随着年龄的增长,甲状腺结节的检出率增长明显(χ2趋势=43.638, P<0.001);不同年龄段甲状腺癌的检出率之间差异无统计学意义(χ2=3.220, P=0.666)。多因素Logistic回归分析显示：女性（OR=1.749）、年龄增加（OR=1.036）和空腹血糖(FPG)升高（OR=1.012）是甲状腺结节发病的独立危险因素(P<0.05)。结论：内科住院患者的甲状腺结节的检出率较高,性别和年龄是影响甲状腺结节检出率分布特征的重要因素。对于女性、年龄较大的老年住院患者伴有空腹血糖(FPG)等,应当普遍行甲状腺超声筛查,以便于早期发现和早期诊断甲状腺结节及甲状腺癌。     

甲状腺癌手术患者预后和生活质量相关影响因素分析

目的分析甲状腺癌手术患者预后和生活质量的相关影响因素,为甲状腺癌患者的临床治疗和康复提供一定的临床参考。方法选取2008年1月至2013年8月间收治确诊甲状腺癌患者102例,对影响患者预后生存率及生活质量的因素进行Logstic回归分析。结果临床分期(OR=6.642,P<0.05)、淋巴结转移(OR=4.840,P<0.05)和年龄(OR=2.441,P<0.05)为影响预后的独立危险因素。病程(OR=4.472,P<0.05)、医疗费用来源(OR=3.320,P<0.05)和婚姻状况(OR=1.488,P<0.05)为影响手术后生活质量的独立危险因素。结论影响甲状腺癌患者预后和生活质量的因素较多,甲状腺癌的外科治疗应综合考虑多方面因素,按照循证医学的原理实施个体化的治疗方案。     

血清促甲状腺素水平与甲状腺癌发病的相关性

目的 观察血清促甲状腺素(TSH)水平与甲状腺癌发病的关系.方法 回顾性分析330例(恶性99例,良性231例)行甲状腺手术的甲状腺疾病患者的血清TSH水平、性别、年龄、肿瘤类型、结节个数,并探讨其与甲状腺癌发生之间的关系.结果 在年龄＜20岁和≥70岁的患者中,甲状腺癌所占的比例分别为63.0％和58.3％,明显高于60 ～ 69岁组(23.3％,均P＜0.05).在81例男性患者中,甲状腺癌所占的比例为43.2％,明显高于女性患者(25.7％,P=0.003).在112例单结节患者中,甲状腺癌所占的比例为42.0％,明显高于多结节患者(23.9％,P＜0.001).在TSH＜ 0.28mIU/L组和≥4.20 mIU/L组患者中,甲状腺癌所占的比例分别为54.6％和50.0％,均明显高于0.28～1.44 mIU/L组(16.1％,均P＜0.05);在正常TSH范围内,甲状腺癌所占与的比例随TSH水平的升高而升高(P ＜0.001).血清TSH水平高(OR=1.465,P=0.014)、男性(OR=1.964,P=0.016)以及单个甲状腺结节( OR=2.090,P=0.006)均为发生甲状腺癌的独立危险因素.结论 血清TSH水平高、男性、单个甲状腺结节者患甲状腺癌的风险高.     

现代生活方式与甲状腺疾病

目的:调查现代生活方式与甲状腺疾病的相关性。方法:选取2016年01月至2016年12月期间入住我科需要手术的甲状腺疾病患者进行问卷调查。对照组选择本院的医务工作者，经我院超声检查确定无甲状腺疾病。问卷内容包括基本情况、饮食习惯、生活方式与情绪以及周边环境。结果:最终纳入甲状腺疾病患者290例，健康人群379例。单因素分析发现两组患者在经常食用腌制/熏制食物、经常食用隔夜饭菜、经常生闷气、遇事不与人倾诉、经常焦虑、工作性质等方面存在显著差异。多因素Logistic回归分析结果显示，经常食用腌制/熏制食物（OR=15.45，95%CI=3.433~69.523）、经常生闷气（OR=1.043，95%CI=1.043~4.202）以及脑力工作（OR=2.035，95%CI=1.059~3.910）为甲状腺疾病患病的危险因素。结论:甲状腺疾病的发生与日常饮食以及社会心理因素密切相关。     

乳腺癌患者心理社会因素与免疫功能的相关性

免疫系统在肿瘤进展中有重要作用,心理社会因素也会影响肿瘤的发生、发展.乳腺癌相关心理社会因素主要包括应激性生活事件、应对方式、情绪和个性特征以及社会支持.相关免疫应答效应因素包括T淋巴细胞及其亚群等特异性免疫之间的关系,作为乳腺癌心理治疗的基础,具有重要意义.     

甲状腺癌危险因素研究进展

目的:总结国内外有关甲状腺癌(TC)相关危险因素的研究进展.方法:应用检索PubMed和CNKI医学期刊全文数据库检索系统,以“甲状腺癌、危险因素”为关键词,检索2001-01-2011-12有关文献.纳入标准:1)TC危险因素,2)引起TC发病率增加的疾病或状态,3)在TC中高表达的基因.根据标准,纳入分析53篇参考文献.结果:多种因素与TC发生有关,其中辐射暴露、碘摄入过量、TC的家族史是TC较明确的危险因素.年龄、性别、体质量、术前血清TSH值、血清TgAb值、良性甲状腺状态、桥本甲状腺炎等与TC关系密切,BRAF、RAS和RET/PTC等被认为与TC相关.大多研究认为甲状腺结节的大小与数目与TC的危险性无明显相关性.结论:TC是一种多种危险因素引起的疾病,明确危险因素,对于术前结节性质的判定具有重要作用.     

甲状腺乳头状癌预后相关因素研究进展

甲状腺乳头状癌的发病率在全球范围内呈上升趋势,因为预后良好,这些患者一度被认为是低风险的。然而,局部晚期以及转移性甲状腺乳头状癌的发病率也在上升,与之相关的死亡率也在增加。因此,如何对甲状腺乳头状癌患者进行预后评估是当下研究的热点,本文将对现阶段甲状腺乳头状癌预后相关因素的研究进行综述。     

Risk factors for malignancy in multinodular goitres.

BACKGROUND: Multinodular goitre (MNG) is quite often associated with thyroid carcinoma, but the risk factors for malignancy are not well known. The aim is to analyse patients with thyroid carcinoma associated with MNG to determine the clinical risk factors for malignancy. METHOD: From a series of 672 MNGs we analysed a subgroup of 59 patients presenting with an associated thyroid carcinoma. The variables analysed were age, sex, family history, cervical radiation therapy, residence in areas of endemic goitre, prior thyroid surgery, time of evolution, asymptomatic status, hyperthyroidism, compressive syndromes, intrathoracic prolongation, goitre consistency and cervical adenopathies. These were compared to MNGs not developing malignancy using the Chi-squared test, Student's t test and a logistic regression test. RESULTS: Of the 59 cases, 37 corresponded to a microcarcinoma (< or =1 cm). The most common histological type was papillary (n=48), followed by follicular (n=6). In 20 cases the carcinoma was multifocal, and capsular involvement was noted in 16 patients, lymph node involvement in five and vascular involvement in another five. The multivariate analysis confirmed the following as independent variables associated with the presence of carcinoma: family history of thyroid pathology (RR=1.6), history of cervical radiation therapy (RR=1.8), recurrent goitre (RR=2.1) and presence of adenopathies on physical exploration (RR=1.6). CONCLUSION: The risk factors for carcinoma associated with MNG are family history of thyroid pathology, personal history of cervical radiation therapy, prior surgery and presence of cervical adenopathies.     

Optimizing treatment for children and adolescents with papillary thyroid carcinoma in post-Chernobyl exposed region: The roles of lymph node dissections in the central and lateral neck compartments

There is lack of data to predict lymph node metastases in pediatric thyroid cancer. The aims are to study (1) the factors affecting the lymph node metastases in children and adolescence with papillary thyroid carcinoma in region exposed to radiation and (2) to evaluate the predictive significance of these factors for lateral compartment lymphadenectomy. Five hundred and nine patients with papillary thyroid carcinoma underwent total thyroidectomy and lymph nodes resection (central and lateral compartments of the neck) surgery during the period of 1991–2010 in Belarus were recruited. The factors related to lymph node metastases were studied in these patients. In the patients with papillary thyroid carcinoma, increase number of cancer-positive lymph nodes in the central neck compartment were associated with a risk to develop lateral nodal disease as well as bilateral nodal disease. Futhermore, positive lateral compartment nodal metastases are associated with age and gender of the patients, tumour size, minimal extra-thyroidal extension, solid architectonic, extensive desmoplasia in carcinoma, presence of psammoma bodies, extensive involvement of the thyroid and metastatic ratio index revealed after examination of the central cervical chain lymph nodes. The presence of nodal disease, degree of lymph node involvement and the distribution of lymph node metastases significantly increase the recurrence rates of patients with papillary thyroid carcinoma. To conclude, the lymph nodes metastases in young patients with papillary thyroid carcinoma in post-Chernobyl exposed region are common and the pattern could be predicted by many clinical and pathological factors.     

Management of thyroid carcinoma-an experience in Bangladesh

All patients (n=154) of thyroid malignancy admitted in the Otoluryngology Department of Bangabandhu Sheikh Mujib Medical University (former IPGMR) between 1986 and 2000 were retrospectively analyzed to find out the extent and result of surgery used for thyroid carcinoma. The other objectives were to find out the incidence of differentiated thyroid carcinoma among the thyroid malignancy and also to find out the age, sex and clinical presentation of papillary and follicular carcinoma. Among all the thyroid malignancy (n-154), Differentiated Thyroid Carcinoma (DTC) was seen in 130 (84.41%) cases, where as papillary carcinoma occurred in 98(63.64%), and follicular carcinoma in 32(20.77%)cases. On the basis of risk factors, the DTC were designated as low and high risk. The year-wise incidence of DTC revealed increasing trend from 1986 (3 cases) to 2000 (23 cases). Among the 98 papillary thyroid carcinoma highest number of cases (35.71%) were seen in 31-40 year age group. The male to female ratio was 1: 1.64. In follicular carcinoma, highest number (35.25%) of cases were also seen in 31-40 year age group. The male to female ratio was 1:1.66. The commonest presentation in papillary carcinoma was thyroid swelling (96.93%). The other presentations were occult thyroid (3.06%), Cervical lymph node metastasis (38.77%) and distant metastasis (2.04%). In Follicular carcinoma, the presentations were thyroid swelling (100%), Cervical lymph node metastasis (6.25%) and Distant metastasis (21.87%). In this series, low risk DTC were treated by Lobectomy & Isthmusectomy plus Thyroxin. In low risk group the rate of recurrence was 6.89% and the mortality was nil in five years follow-up. Except two inoperable cases, all high risk patients were managed by Total thyroidectomy (with or without neck dissection, plus removal of metastatic lesion when required) with Radioiodine ablation plus Thyroxin. . The rate of recurrence was 7.81% and mortality was 1.56% in high risk group in similar period of time. Vocal cord palsy were noted in 5 (3.84%) unilateral, and inane (0.76%) bilateral cases. Hypoparathyroidism was found in 4.61%.     

甲状腺癌的流行现状及危险因素

甲状腺癌的发病与多种因素有关,辐射是明确的危险因素,碘摄取量与甲状腺癌的关系仍存在争议.研究表明,多个信号传导通路中遗传学和表观遗传学的改变是甲状腺癌分子致病机制的核心.另外,促甲状腺素、体重指数和慢性淋巴细胞性甲状腺炎也与甲状腺癌的发生有关.     

Management of the central compartment in differentiated thyroid carcinoma

Management of differentiated thyroid carcinoma (DTC) is gradually evolving with considerations of de-escalation of treatment and/or active surveillance in a significant proportion of patients on the basis of an improved understanding of the long-term disease and functional outcomes from both surgical and non-surgical approaches. This is fueled by improved risk stratification using clinicopathologic prognostic factors as determined through high resolution ultrasound and fine needle aspiration cytology. This paper discusses general recommendations for preoperative decision-making in the management of the central compartment in DTC with particular reference to micropapillary thyroid carcinoma and encapsulated follicular variant papillary thyroid carcinoma. Given the multitude of specific factors that must be considered for each patient, therapeutic decisions should occur in a multidisciplinary setting weighing the risks of treatment morbidity against the risks of disease progression or recurrence. Recurrent/persistent disease merits special attention with regard to pre-operative planning and surgical risk, and should be managed by high-volume thyroid surgeons.     

结节性甲状腺肿与甲状腺癌的关系以及甲状腺切除术后复发的原因

目的 探讨结节性甲状腺肿与甲状腺癌的关系以及甲状腺切除术后复发的原因.方法 选择甲状腺结节患者,一共260例,回顾性分析患者术后复发有关的因素.结果 良性结节性甲状腺肿235例,伴有乳头状增生35例,占14.89％;伴有非典型增生30例,占12.77％,伴有癌变均为微小癌5例,占2.13％.甲状腺癌25例,其中乳头状癌15例,占甲状腺癌60％;滤泡癌5例,占20％;髓样癌1例,占4％,未分化癌4例,占16％.甲状腺癌周围组织伴有结节性甲状腺肿病变为20例,占甲状腺癌的80％.随访期间复发病例一共20例,占7.69％.肿瘤大小、手术方式、病理类型、是否行淋巴结清扫与术后复发具有显著相关性.影响手术预后情况的独立因素包括肿瘤最大直径>4 cm、手术方式为单侧腺叶加峡部切除、病理类型为未分化癌、未作淋巴结清扫.结论 结节性甲状腺肿是甲状腺癌的癌前病变,甲状腺切除术后患者复发的危险因素广泛而复杂.     

Benign and malignant thyroid nodules after neck irradiation

A total of 444 persons were examined for the presence of thyroid nodules on average of 43 years after having been treated with x-rays for cervical tuberculous adenitis. Of this total, 101 subjects had undergone surgery for thyroid nodules: 25 for carcinoma (6%) and 76 for benign nodules (17%). Carcinoma occurred with the same frequency in multinodular and uninodular glands. Because of the uneven age distribution in the current series, it could not be decided whether there was a higher susceptibility of the young thyroid to the induction of thyroid carcinoma or benign nodules. The dosage range for the whole series was 0.40 to 50.90 Gy (40-5090 rad). There was a positive correlation between the absorbed radiation dose and the probability of developing benign and malignant thyroid nodules, even after doses of 20 Gy or more. The risk of developing thyroid carcinoma was equal for men and women, while the female-to-male ratio for benign nodules was 2.9:1, indicating that risk factors associated with females are of less importance in irradiated than in nonirradiated populations. The median latency for carcinoma was 40 years, suggesting that the increased risk of thyroid carcinoma after irradiation remains for the rest of the patient's life.     

Risks of papillary and follicular thyroid cancer among immigrants to Sweden

Previous studies have indicated that ionizing radiation, particularly during childhood, is the main established risk factor for thyroid cancer. History of benign nodules/adenoma, goiter, iodine deficiency or high-iodine intake might be other associated factors. We wanted to define the histology-specific thyroid cancer risk in the first-generation immigrants to Sweden. We used the 2010 update of the nation-wide Swedish Family-Cancer Database (>12 million individuals; 1.8 million immigrants; histology code in force since 1958) to calculate standardized incidence ratios (SIRs) for histology-specific thyroid cancer among immigrants compared to the native Swedes. The patient series covered 2,604 male and 6,406 female Swedes, and 247 and 863 immigrants. The median age at immigration was 29 years, and the median age at thyroid cancer diagnosis was 46 years. Increased risks for female papillary carcinoma were observed for Finns (SIR = 1.63), former Yugoslavians (2.36), Russians (2.34), other East Europeans (2.14), Turks (3.16), Iranians (2.68), Iraqis (2.77), East and Southeast Asians (2.92), other Asians (1.69) and South Americans (2.23). Male Iranians (2.85), East and Southeast Asians (3.57) and other Asians (2.26) had an increased risk for papillary carcinoma. Only male East and Southeast Asians (2.93) had an increased risk for follicular carcinoma. The data might suggest that immigrant populations in Sweden from areas of low or high-iodine intake are at risk of papillary carcinoma, implicating iodine imbalance as a contributing factor to our findings. The increased risk of thyroid cancer among Asian immigrants may confirm the role of childhood-ionizing radiation on thyroid cancer risk.