【摘要】：目的:探討體重指數(shù)及雌激素水平與分化型甲狀腺癌的相關性,為臨床診斷及治療分化型甲狀腺癌提供依據(jù)。方法:回顧性分析2014年10月~2016年10月間就診于吉林大學白求恩第一醫(yī)院甲狀腺外科,并由同一教授手術組進行治療的1242例甲狀腺患者資料,其中分化型甲狀腺癌患者917例,甲狀腺良性腫瘤325例。將917例分化型甲狀腺癌患者與甲狀腺良性腫瘤的325例患者的病例資料進行對比研究,單因素分析找到影響分化型甲狀腺癌的因素,同時將單因素分析具有意義的結果納入多因素分析,經(jīng)過多因素回歸分析找到影響分化型甲狀腺癌的危險因素。分析比較體重指數(shù)及雌激素水平與分化型甲狀腺癌的相關性。根據(jù)世界衛(wèi)生組織定義超重、肥胖的標準,即BMI25kg/m2為正常組,25kg/m2≤BMI30kg/m2為超重組,BMI≥30kg/m2為肥胖組,比較不同組中分化型甲狀腺癌的臨床特點,同時分析比較BMI每增加5kg/m2發(fā)生分化型甲狀腺的風險。由于男性及女性的基礎雌激素水平不同,分別比較男性及女性不同雌激素水平的臨床基本特征差異,同時比較不同雌激素水平的分化型甲狀腺癌的病理學特點的差異;女性患者根據(jù)既往有無內(nèi)分泌疾病相關病史分為兩組,比較兩者之間各臨床資料的特點。結果:(1)917例分化型甲狀腺癌中,男性155例,女性762例,男女比例為1:4.9;(2)單因素分析:(1)分化型甲狀腺癌患者中體重指數(shù)≥25 Kg/m2占42.0%(398/917),隨著體重指數(shù)的增加,患分化型甲狀腺癌的風險增加了1.35倍(OR=1.35,95%:1.04-1.75,P=0.026);(2)隨著雌二醇水平的增加,患分化型甲狀腺癌的風險增加了2.54倍(OR=2.54,95%:1.95-3.31,P0.001)。(3)多因素Logistic回歸分析結果顯示,年齡≤45歲、TSH2.11m U/L、BMI≥25Kg/m2是影響分化型甲狀腺癌發(fā)生的危險因素;(4)體重指數(shù)與分化型甲狀腺癌的關系:(1)體重每增加5Kg/m2罹患分化型甲狀腺癌的風險隨之增加,差異具有統(tǒng)計學意義(P=0.049);(2)體重指數(shù)與分化型甲狀腺癌的惡性程度不具有一定相關性;(5)雌激素水平與分化型甲狀腺癌的關系:1)對于女性患者:(1)雌激素水平175pmol/L時,患分化型甲狀腺癌的比率占84.5%(432/511),雌激素水平≤175 pmol/L時,患分化型甲狀腺癌的比率占64.6%(330/511),差異具有統(tǒng)計學意義(P0.05);(2)雌激素175 pmol/L的女性DTC患者淋巴結轉移率44.4%(192/432),雌激素≤175pmol/L的女性DTC患者淋巴結轉移率為33.9%(112/330),差異具有統(tǒng)計學意義(P0.05);(3)既往具有內(nèi)分泌相關疾病病史(乳腺癌、乳腺纖維瘤、乳腺結節(jié)、子宮肌瘤、卵巢囊腫)的患者患分化型甲狀腺癌的比率占83%(117/141),既往無內(nèi)分泌相關疾病病史患分化型甲狀腺癌的比率占73.2%(645/881),差異具有統(tǒng)計學意義(P0.05)。2)對于男性患者:(1)男性雌激素水平113 pmol/L患分化型甲狀腺癌的比率占76.8%(86/112),雌激素113pmol/L發(fā)生占63.9%(69/108),差異具有統(tǒng)計學意義(P0.05)。結論(1)患者的年齡≤45歲、TSH2.11m U/L、BMI≥25Kg/m2是影響分化型甲狀腺癌的危險因素,應予以重視;(2)隨著體重指數(shù)的增加,患分化型甲狀腺癌的風險增加,臨床對于體重超標患者應予以重視;(3)體重指數(shù)與分化型甲狀腺癌的惡性程度不具有一定相關性;(4)女性雌激素水平增高患分化型甲狀腺癌的風險增大,同時更容易伴有淋巴結轉移;(5)既往具有內(nèi)分泌相關疾病病史的女性患分化型甲狀腺癌的風險增加,同時證明雌激素水平的變化對分化型甲狀腺癌的發(fā)生發(fā)展具有一定的影響;(6)男性患者雌激素水平增高,更容易患分化型甲狀腺癌。
[Abstract]:Objective: To investigate the correlation between body mass index and estrogen level and differentiated thyroid carcinoma, and to provide a basis for clinical diagnosis and treatment of differentiated thyroid cancer. Methods: retrospective analysis of 1242 cases of thyroid surgery in Bethune First Hospital of Jilin University in October 2014, and 1242 cases of the same professor's operation group. There were 917 patients with differentiated thyroid cancer and 325 cases of benign thyroid tumor, 917 cases of differentiated thyroid cancer and 325 cases of benign thyroid tumor were compared. Single factor analysis found the factors affecting differentiated thyroid cancer, and the single factor analysis had significant results. The risk factors affecting differentiated thyroid cancer were found through multiple factor analysis. The correlation between body mass index and estrogen level and differentiated thyroid cancer was analyzed and compared. According to the WHO definition of overweight and obesity, BMI25kg/m2 was a normal group, 25kg/m2 < BMI30kg/m2 was superrecombinant, BMI > 30kg /m2 was the obese group, compared the clinical characteristics of differentiated thyroid carcinoma in different groups, and compared the risk of differentiated thyroid gland in each increase of 5kg/m2 in BMI. The basic characteristics of different estrogen levels in men and women were compared, and the different estrogen levels were compared, and the different estrogen levels were compared. Differences in pathological characteristics of flat differentiated thyroid carcinoma; women were divided into two groups according to the history of previous endocrine disease related diseases. Results: (1) 917 cases of differentiated thyroid carcinoma, 155 male, 762 female, male and female 1:4.9; (2) single factor analysis: (1) differentiated thyroid carcinoma The body mass index (BMI) more than 25 Kg/m2 accounted for 42% (398/917), and with the increase of body mass index, the risk of differentiated thyroid cancer increased by 1.35 times (OR=1.35,95%: 1.04-1.75, P=0.026); (2) the risk of differentiated thyroid cancer increased with the increase of estradiol (OR=2.54,95%: 1.95-3.31, P0.001). (3) multiple factor Logistic regression The analysis showed that age less than 45 years old, TSH2.11m U/L, BMI > 25Kg/m2 were the risk factors for the development of differentiated thyroid carcinoma; (4) the relationship between BMI and differentiated thyroid carcinoma: (1) the risk of differentiated thyroid carcinoma increased with each increase of 5Kg/m2, and the difference was statistically significant (P=0.049); (2) BMI and differentiation The malignant degree of thyroid carcinoma was not related; (5) the relationship between estrogen level and differentiated thyroid carcinoma: (1) for female patients: (1) the ratio of differentiated thyroid cancer was 84.5% (432/511) when estrogen level was 175pmol/L, and the ratio of differentiated thyroid cancer was 64.6% (330/511) when estrogen level was less than 175 pmol/L. There were statistical significance (P0.05); (2) the lymph node metastasis rate of female DTC patients with estrogen 175 pmol/L was 44.4% (192/432), and the lymph node metastasis rate of female DTC patients with estrogen less than 175pmol/L was 33.9% (112/330), and the difference was statistically significant (P0.05); (3) the history of endocrine related diseases (breast cancer, mammary fibroma, breast nodule, uterus) The ratio of differentiated thyroid cancer in the patients with myoma and ovarian cyst was 83% (117/141), the rate of differentiated thyroid cancer with no history of endocrine related diseases accounted for 73.2% (645/881), and the difference was statistically significant (P0.05).2) for male patients: (1) the ratio of male sex estrogen level 113 pmol/L to differentiated thyroid cancer was 76.8% (86) /112), the occurrence of estrogen 113pmol/L is 63.9% (69/108), and the difference is statistically significant (P0.05). Conclusion (1) the age of the patients is less than 45 years old, TSH2.11m U/L, BMI or 25Kg/m2 is a risk factor affecting differentiated thyroid cancer. (2) with the increase of body mass index, the risk of differentiated thyroid cancer is increased and the clinical weight is beyond the standard. Patients should be paid attention to; (3) there is no correlation between BMI and the malignancy of differentiated thyroid cancer; (4) increased risk of differentiated thyroid cancer in women with higher estrogen levels and more likely to be accompanied by lymph node metastasis; (5) the risk of differentiated thyroid cancer in women with a history of Endocrinology and disease is increased. It is also proved that the change of estrogen level has certain influence on the development and development of differentiated thyroid cancer. (6) the level of estrogen in male patients is higher, and it is easier to develop differentiated thyroid cancer.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.1

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