本文關(guān)鍵詞：身體質(zhì)量指數(shù)與甲狀腺乳頭狀癌侵襲性的關(guān)系的臨床研究　出處：《山東大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 甲狀腺乳頭狀癌 身體質(zhì)量指數(shù) 臨床病理學(xué)因素

【摘要】：目的:研究身體質(zhì)量指數(shù)(Body mass index,BMI)與甲狀腺乳頭狀癌侵襲性指標(biāo)的相關(guān)性,探討其與甲狀腺乳頭狀癌侵襲性的關(guān)系。方法:收集山東省立醫(yī)院乳腺甲狀腺外科2011.1.1—2012.12.31間行甲狀腺手術(shù)的461例病例資料(均經(jīng)病理證實(shí)為甲狀腺乳頭狀癌),進(jìn)行回顧性分析。以WHO標(biāo)準(zhǔn)將患者按BMI分為:偏瘦組(18.5kg/m2,n=11)正常組(18.5～24.9%kg/m2,n=233)、超重組(25.0kg/m2,n=217)。統(tǒng)計(jì)各組的甲狀腺乳頭狀癌侵襲性指標(biāo)(腫瘤直徑、TNM分期、單發(fā)或多發(fā)、是否存在淋巴結(jié)轉(zhuǎn)移及包膜外侵襲),由于分組后偏瘦組樣本量過(guò)小(n=11),為避免統(tǒng)計(jì)偏差,擯除該組數(shù)據(jù),僅對(duì)正常組和超重組數(shù)據(jù)行對(duì)比分析。使用SPSS 19.0版軟件進(jìn)行統(tǒng)計(jì)分析,卡方檢驗(yàn)行單因素分析。當(dāng)P值0.05時(shí),認(rèn)為具有統(tǒng)計(jì)顯著性。結(jié)果:本次研究共入組461例(男性106例和女性355例)甲狀腺乳頭狀癌患者。177例(38.4%)腫瘤存在甲狀腺包膜外侵襲;中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移和側(cè)頸區(qū)淋巴結(jié)轉(zhuǎn)移的例數(shù)分別占總統(tǒng)計(jì)患者人數(shù)的52.3%(n=234)和35.1%(n=162),其中,128例(27.8%)同時(shí)有中央?yún)^(qū)淋巴結(jié)和側(cè)頸區(qū)淋巴結(jié)轉(zhuǎn)移;7例患者(1.5%)有遠(yuǎn)處轉(zhuǎn)移;192例患者(41.6%)為多灶性甲狀腺乳頭狀癌;148例患者(32.1%)術(shù)后病理證實(shí)為高TNM分期(Ⅲ期或Ⅳ期);13例患者(2.8%)有血管侵犯現(xiàn)象。甲狀腺乳頭狀癌侵襲性指標(biāo)分析:1)原發(fā)腫瘤大小:正常組腫瘤直徑≤1cm的病例數(shù)為136(58.3%),腫瘤直徑1cm的病例數(shù)為97(41.7%)。超重組腫瘤直徑≤1cm的病例數(shù)為102(47.0%),腫瘤直徑1cm的病例數(shù)為115(53.0%)。其卡方檢驗(yàn):P=0.0160.05,差異有統(tǒng)計(jì)學(xué)意義。2)腫瘤包膜外侵襲:正常組包膜外侵襲的病例數(shù)為64(27.5%),未發(fā)生侵襲的病例數(shù)為169(72.5%)。超重組包膜外侵襲的病例數(shù)為111(51.2%),未發(fā)生侵襲的病例數(shù)為106(48.8%)。其卡方檢驗(yàn):P0.001,有統(tǒng)計(jì)學(xué)差異。3)腫瘤多灶性:正常組單發(fā)腫瘤病例數(shù)為142(60.9%),多發(fā)腫瘤的的病例數(shù)為91(39.1%)。超重組單發(fā)腫瘤的病例數(shù)為118(54.4%),多發(fā)腫瘤的病例數(shù)為99(45.6%)。其卡方檢驗(yàn):P0.05,無(wú)統(tǒng)計(jì)學(xué)差異。4)腫瘤TNM分期:正常組TNM分期為Ⅰ+Ⅱ期病例數(shù)為173(74.2%),TNM分期為Ⅲ+Ⅳ期的病例數(shù)為60(25.8%)。超重組TNM分期為Ⅰ+Ⅱ期病例數(shù)為132(60.8%),Ⅲ+Ⅳ期的病例數(shù)為85(39.2%)。其卡方檢驗(yàn):P0.05,有統(tǒng)計(jì)學(xué)差異。5)腫瘤頸部淋巴結(jié)轉(zhuǎn)移:正常組頸部淋巴結(jié)有轉(zhuǎn)移的病例數(shù)為124(53.2%),頸部淋巴結(jié)無(wú)轉(zhuǎn)移的病例數(shù)為109(46.8%)。超重組頸部淋巴結(jié)有轉(zhuǎn)移的病例數(shù)為136(62.7%),頸部淋巴結(jié)無(wú)轉(zhuǎn)移的病例數(shù)為81(37.3%)。其卡方檢驗(yàn):P0.05,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.甲狀腺乳頭狀癌患者中:1)原發(fā)腫瘤大小比較中,超重組比正常組更易出現(xiàn)較大直徑的原發(fā)腫瘤。2)超重組比正常組更易發(fā)生包膜外侵襲。3)超重組處在更高的TNM分期的患者比例較正常組高。4)超重組比正常組更易發(fā)生腫瘤頸部淋巴結(jié)轉(zhuǎn)移。5)在腫瘤多灶性方面,兩組未表現(xiàn)明顯統(tǒng)計(jì)學(xué)差異。2.高BMI患者應(yīng)視為具有高侵襲潛能的高危甲狀腺腫瘤患者,臨床應(yīng)積極治療并加強(qiáng)隨訪觀察。
[Abstract]:Objective: To study the body mass index (Body mass, index, BMI) associated with thyroid papillary carcinoma and invasive index, explore its relationship with the invasiveness of papillary thyroid carcinoma. Methods: collect breast and thyroid surgery Shangdong Province-owned Hospital 2011.1.1 2012.12.31 underwent surgery of thyroid gland (461 cases were pathologically confirmed thyroid papillary carcinoma), were retrospectively analyzed. The patients according to the BMI WHO standard will be divided into: lean group (18.5kg/m2, n=11) and normal group (18.5 ~ 24.9%kg/m2, n=233), overweight (25.0kg/m2, n=217). Each group of statistical indicators of invasive papillary thyroid carcinoma (tumor diameter, TNM stage. Single or multiple, whether there is lymph node metastasis and capsule invasion), after grouping the lean due to the small sample size (n=11), in order to avoid statistical errors, discard the set of data, only the analysis of normal group and overweight group data comparison. The use of SPSS 19 鐗堣蔣浠惰繘琛岀粺璁″垎鏋，

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