本文選題：BMI + 肥胖��； 參考：《濟(jì)南大學(xué)》2017年碩士論文

【摘要】：目的甲狀腺乳頭狀癌(Papillary Thyroid Carcinoma,PTC)發(fā)病率近年來(lái)持續(xù)攀升,肥胖已被認(rèn)為是甲狀腺乳頭狀癌發(fā)病的獨(dú)立危險(xiǎn)因素。然而,體重增加是否促進(jìn)PTC惡性生物學(xué)行為,影響PTC預(yù)后尚不明確。本研究目的為明確體重指數(shù)(Body Mass Index,BMI)與甲狀腺乳頭狀癌的臨床病理特征的關(guān)系。方法796例甲狀腺乳頭狀癌患者入組回顧性分析。Logistic回歸模型用于評(píng)價(jià)BMI增加與各臨床病理特征相關(guān)性的OR值。進(jìn)一步利用Logistic回歸模型進(jìn)行組間對(duì)比,分析超重組(overweight)、肥胖組(obese)患者臨床病例特征差異,分析過(guò)程中正常體重組(normal weight)作為對(duì)照組。采用非參數(shù)檢驗(yàn)分別比較超重組、肥胖組與正常體重組中央?yún)^(qū)及側(cè)頸部淋巴結(jié)轉(zhuǎn)移數(shù)差異。結(jié)果本研究入組796例患者,男性:女性患者比例約1:3,入組人群平均年齡為(46.2±11.5)歲,平均體重指數(shù)為(25±3.40)kg/m2。Logistic回歸分析顯示:體重指數(shù)增加與甲狀腺乳頭狀癌腫瘤大小(OR=1.267,P=0.027)、侵犯包膜(OR=2.201,P0.001)、多發(fā)灶(OR=1.31,P=0.01)、腫瘤分期較晚(OR=1.479,P=0.004)存在明確相關(guān)性。利用Logistic回歸模型組間對(duì)比分析顯示超重組、肥胖組相對(duì)于正常體重組腫瘤大小1cm的OR值分別為1.53(CI:1.14-2.06,P=0.005)、1.96(CI:1.15-3.34,P=0.014),發(fā)生侵犯包膜的OR值分別為2.42(CI:1.78-3.3,P0.001)、4.23(CI:2.4-7.3,P0.001);超重組較正常體重組臨床分期較晚的OR值為1.83(CI:1.33-2.52,P0.001);肥胖組較正常體重組發(fā)生側(cè)頸部(II-V區(qū))±中央?yún)^(qū)淋巴結(jié)(VI區(qū))淋巴結(jié)轉(zhuǎn)移的OR值為1.92(CI:1.12-3.27,P=0.017)。非參數(shù)檢驗(yàn)進(jìn)一步分析BMI與頸部淋巴結(jié)轉(zhuǎn)移的相關(guān)性,分析結(jié)果顯示超重組轉(zhuǎn)移至中央?yún)^(qū)和側(cè)頸部淋巴結(jié)數(shù)目較正常體重組增加且差異有統(tǒng)計(jì)學(xué)意義(P=0.014、P=0.05);肥胖組轉(zhuǎn)移至中央?yún)^(qū)和側(cè)頸部淋巴結(jié)數(shù)目較正常體重組增加且差異有統(tǒng)計(jì)學(xué)意義(P=0.013、P=0.017)。結(jié)論高BMI與甲狀腺乳頭狀癌腫瘤大小、侵犯包膜、頸部淋巴結(jié)轉(zhuǎn)移等侵襲性臨床病理特征存在相關(guān)性。高體重指數(shù)患者初次就診時(shí)腫瘤TNM分期普遍較晚。這項(xiàng)研究表明超重與肥胖人群應(yīng)采取更為積極的PTC治療方案,但這需要進(jìn)一步研究證明。
[Abstract]:Objective the incidence of papillary Thyroid carcinomas has been increasing in recent years. Obesity has been regarded as an independent risk factor for papillary thyroid carcinoma.However, it is not clear whether weight gain promotes PTC malignant biological behavior and affects the prognosis of PTC.Objective to study the relationship between body Mass index (BMI) and clinicopathological features of papillary thyroid carcinoma.Methods 796 patients with papillary thyroid carcinoma were analyzed retrospectively. Logistic regression model was used to evaluate the OR value of the correlation between the increase of BMI and the clinicopathological characteristics.Further more, Logistic regression model was used to compare the clinical characteristics of patients with hyperrecombination overweight and obesity, and normal weight group was used as control group in the course of analysis.Nonparametric tests were used to compare the number of lymph node metastases in the central region and lateral neck between the obese group and the normal weight group.Results there were 796 patients in this study. The proportion of male to female patients was about 1: 3. The average age of the group was 46.2 鹵11.5 years old.The average body mass index (BMI) was 25 鹵3.40)kg/m2.Logistic regression analysis. The results showed that there was a clear correlation between the increase of BMI and the size of thyroid papillary carcinoma tumor (1.267 P0.027), the invasion of the capsule (2.201) (P0.001), the multiple foci (OR1.31) and the late stage of the tumor (1.479P0.004).The results of Logistic regression model showed superrecombination.The OR values of tumor size 1cm in obese group were 1.53 CI: 1.14-2.06P0. 005, CI: 1.15-3.34%, OR value of invading capsule were 2.42 CI: 1.78-3.3 P0.0014.23 CIV2.4-7.3P0.001; OR value of clinical stage of overweight group was 1.83 CI: 1.33-2.52P 0.001respectively; the OR value of overweight group was 1.83CI: 1.33-2.52P 0.001respectively, and that of obese group was 1.42CIw 1.78-3.3n (P 0.001) respectively; the OR value of overweight group was 1.83CI: 1.33-2.52P 0.001respectively; the OR value of obese group was 1.83% CI: 1.33-2.52U P0.001P 0.001r = 1.83CI: 1.33-2.52P 0.001respectively.The OR of lymph node metastasis was 1.92% CI: 1.12-3.27% (P < 0.017).Non-parametric test was used to analyze the correlation between BMI and cervical lymph node metastasis.The results showed that the number of lymph nodes transferred to the central area and lateral cervical lymph nodes in the obesity group was significantly higher than that in the normal body weight group, and the number of lymph nodes in the obesity group was higher and worse than that in the normal body weight group.The difference was statistically significant (P = 0.013, P = 0.017).Conclusion High BMI is associated with invasive clinicopathological features of papillary thyroid carcinoma, such as tumor size, invasion of capsule and cervical lymph node metastasis.Tumor TNM staging was generally late in patients with high body mass index (BMI) at first visit.The study suggests that overweight and obese people should take more aggressive PTC treatments, but this needs further research to prove.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R736.1

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本文編號(hào)：1765999