【摘要】：目的:探討合并慢性淋巴細(xì)胞性甲狀腺炎(Chronic Lymphocytic Thyroiditis,CLT)的甲狀腺乳頭狀癌(papillary thyroid carcinoma,PTC)的臨床病理特點(diǎn),特別是淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)的情況。方法:連續(xù)收集2013年10月至2015年10月期間在北京協(xié)和醫(yī)院行手術(shù)治療、經(jīng)病理確診的4265例PTC患者的臨床病理資料,分析其臨床病理特點(diǎn),通過(guò)單因素分析明確合并CLT的PTC患者獨(dú)特的臨床病理特點(diǎn);通過(guò)單因素、多因素統(tǒng)計(jì)分析確定包括CLT在內(nèi)的各臨床病理指標(biāo)是否是淋巴結(jié)轉(zhuǎn)移、大量淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素。結(jié)果:4265例PTC患者中,甲狀腺微小乳頭狀癌(papillary thyroid microcarcinoma,PTMC)3059例(71.7%),伴CLT者1010例(23.7%)。合并CLT的PTC患者中,女性909例(90%)、中位年齡43歲、中位腫瘤長(zhǎng)徑0.8cm、多發(fā)灶624例(61.8%),侵犯被膜422例(41.8%),淋巴結(jié)轉(zhuǎn)移429例(42.5%),大量淋巴結(jié)轉(zhuǎn)移133例(13.2%)。與未合并CLT的PTC患者相比,合并CLT的PTC患者,女性比例多(90.0%vs 70.2%,P0.001);中位年齡低(43歲vs 44歲,P=0.001);淋巴結(jié)轉(zhuǎn)移率低(42.5%vs 50.9%,P0.001);腫瘤長(zhǎng)徑、多發(fā)灶比例、侵犯被膜率、大量淋巴結(jié)轉(zhuǎn)移率并無(wú)顯明差異(0.8cm vs 0.7cm,61.8%vs 62.9%,41.8%vs 42.1%,13.2%vs14.5%,均P0.05)。淋巴結(jié)轉(zhuǎn)移多因素分析顯示:CLT是PTC淋巴結(jié)轉(zhuǎn)移的獨(dú)立保護(hù)因素(OR=0.713,95%CI=0.609-0.835,P0.001),但不是大量淋巴結(jié)轉(zhuǎn)移的獨(dú)立保護(hù)因素(OR=0.944,95%CI=0.750-1.188,P=0.621)。發(fā)生淋巴結(jié)轉(zhuǎn)移的PTC患者中,合并CLT者的淋巴結(jié)轉(zhuǎn)移數(shù)量與未合并者無(wú)差異(3個(gè)vs 3個(gè),P=0.300)。結(jié)論:在合并CLT的PTC中,女性更多、更年輕、淋巴結(jié)轉(zhuǎn)移率更低;CLT是PTC淋巴結(jié)轉(zhuǎn)移的獨(dú)立保護(hù)因素;但是發(fā)生轉(zhuǎn)移的患者其淋巴結(jié)轉(zhuǎn)移數(shù)量并未減少。
[Abstract]:Objective: to investigate the clinicopathological features of papillary thyroid carcinoma (papillary thyroid carcinoma,PTC) with chronic lymphocytic thyroiditis (Chronic Lymphocytic Thyroiditis,CLT), especially the risk of lymph node metastasis. Methods: the clinicopathological data of 4265 patients with PTC confirmed by pathology from October 2013 to October 2015 were collected and their clinicopathological characteristics were analyzed. The unique clinicopathological features of PTC patients with CLT were confirmed by univariate analysis. Univariate and multivariate statistical analysis was used to determine whether the clinicopathologic parameters, including CLT, were independent risk factors for lymph node metastasis and a large number of lymph node metastases. Results: of the 4265 patients with PTC, 3059 (71.7%) had (papillary thyroid microcarcinoma,PTMC and 1010 (23.7%) had CLT. Among the PTC patients with CLT, 909 cases (90%) were female. The median age was 43 years old. The median diameter of tumor was 0.8 cm, 624 cases (61.8%) had multiple foci, 422 cases (41.8%) had invasion of capsule, 429 cases (42.5%) had lymph node metastasis. There were 133 cases (13.2%) with massive lymph node metastasis. Compared with PTC patients without CLT, the proportion of PTC patients with CLT was higher (90.0%vs 70.2%, P0.001), the median age was lower (43 years, vs 44 years, P < 0.001). The lymph node metastasis rate was low (42.5%vs 50.9% P0.001); There was no significant difference in the length of tumor, the proportion of multiple foci, the rate of invasion of capsule, the rate of mass lymph node metastasis (0.8cm vs 0.7 cm ~ (-1) 61.8 vs 62.9). Multivariate analysis of lymph node metastasis showed that CLT was an independent protective factor (OR=0.713,95%CI=0.609-0.835,P0.001) for lymph node metastasis of PTC, but not an independent protective factor for a large number of lymph node metastases (OR=0.944,95%CI=0.750-1.188,). P0. 621). In PTC patients with lymph node metastasis, there was no difference in the number of lymph node metastasis between the patients with CLT and those without (3 vs, 0.300). Conclusion: in PTC with CLT, women are more, younger, and the rate of lymph node metastasis is lower, CLT is an independent protective factor of PTC lymph node metastasis, but the number of lymph node metastasis in patients with PTC metastasis has not decreased.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R736.1;R581.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李勵(lì)琦;杭劍萍;;ER、PR在分化型甲狀腺癌組織中的表達(dá)及臨床意義[J];川北醫(yī)學(xué)院學(xué)報(bào);2015年06期

2 董鴻;晏昱婧;劉謹(jǐn)文;易繼林;沈文狀;;血清甲狀腺過(guò)氧化物酶抗體對(duì)合并橋本甲狀腺炎甲狀腺微小癌淋巴結(jié)轉(zhuǎn)移影響[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2015年17期

3 梁冀望;李振東;李樹(shù)春;黃波;劉宏偉;李延國(guó);;家族性與散發(fā)性甲狀腺乳頭狀癌的臨床病理特征分析[J];中華耳鼻咽喉頭頸外科雜志;2015年06期

4 于波洋;馬步云;周潔宏;田野;彭玉蘭;;甲狀腺乳頭狀癌合并橋本氏甲狀腺炎的BRAF基因表達(dá)及侵襲性[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2015年15期

5 倫語(yǔ);吳小雨;辛世杰;段志泉;張健;;橋本甲狀腺炎與甲狀腺乳頭狀癌關(guān)系的臨床研究[J];中國(guó)普通外科雜志;2014年05期

6 李拓;李維卿;盛建國(guó);石勇銓;蔡全才;劉志民;;甲狀腺癌860例臨床特點(diǎn)及手術(shù)預(yù)后影響因素研究[J];中國(guó)實(shí)用內(nèi)科雜志;2014年04期

7 高健;于洋;李小龍;趙靜;趙翠;趙敬柱;劉友忠;李亦工;高明;;家族性甲狀腺非髓樣癌的臨床特征分析[J];中華腫瘤雜志;2014年03期

8 梁軍;趙丹;梁智勇;孟超;林巖松;;甲狀腺乳頭狀癌合并淋巴細(xì)胞性甲狀腺炎臨床病理生物學(xué)特征分析[J];中華腫瘤防治雜志;2013年17期

9 孫嘉偉;許曉君;蔡秋茂;許燕君;顧江;;中國(guó)甲狀腺癌發(fā)病趨勢(shì)分析[J];中國(guó)腫瘤;2013年09期

10 石臣磊;石鐵鋒;吳佳奇;孫宇;秦華東;;橋本甲狀腺炎對(duì)乳頭狀甲狀腺癌頸淋巴結(jié)轉(zhuǎn)移的影響[J];中國(guó)普通外科雜志;2013年05期

相關(guān)會(huì)議論文 前1條

1 李麗;李靜;郭丹;劉苗;范晨玲;王紅;張紅梅;范世光;單忠艷;滕衛(wèi)平;;雌激素受體α和β各自活化對(duì)實(shí)驗(yàn)性自身免疫性甲狀腺炎發(fā)生發(fā)展的影響[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)內(nèi)分泌學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2011年

，

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