体重指数及雌激素水平与分化型甲状腺癌的相关性分析

发布时间：2018-07-21 21:43

【摘要】：目的:探讨体重指数及雌激素水平与分化型甲状腺癌的相关性,为临床诊断及治疗分化型甲状腺癌提供依据。方法:回顾性分析2014年10月~2016年10月间就诊于吉林大学白求恩第一医院甲状腺外科,并由同一教授手术组进行治疗的1242例甲状腺患者资料,其中分化型甲状腺癌患者917例,甲状腺良性肿瘤325例。将917例分化型甲状腺癌患者与甲状腺良性肿瘤的325例患者的病例资料进行对比研究,单因素分析找到影响分化型甲状腺癌的因素,同时将单因素分析具有意义的结果纳入多因素分析,经过多因素回归分析找到影响分化型甲状腺癌的危险因素。分析比较体重指数及雌激素水平与分化型甲状腺癌的相关性。根据世界卫生组织定义超重、肥胖的标准,即BMI25kg/m2为正常组,25kg/m2≤BMI30kg/m2为超重组,BMI≥30kg/m2为肥胖组,比较不同组中分化型甲状腺癌的临床特点,同时分析比较BMI每增加5kg/m2发生分化型甲状腺的风险。由于男性及女性的基础雌激素水平不同,分别比较男性及女性不同雌激素水平的临床基本特征差异,同时比较不同雌激素水平的分化型甲状腺癌的病理学特点的差异;女性患者根据既往有无内分泌疾病相关病史分为两组,比较两者之间各临床资料的特点。结果:(1)917例分化型甲状腺癌中,男性155例,女性762例,男女比例为1:4.9;(2)单因素分析:(1)分化型甲状腺癌患者中体重指数≥25 Kg/m2占42.0%(398/917),随着体重指数的增加,患分化型甲状腺癌的风险增加了1.35倍(OR=1.35,95%:1.04-1.75,P=0.026);(2)随着雌二醇水平的增加,患分化型甲状腺癌的风险增加了2.54倍(OR=2.54,95%:1.95-3.31,P0.001)。(3)多因素Logistic回归分析结果显示,年龄≤45岁、TSH2.11m U/L、BMI≥25Kg/m2是影响分化型甲状腺癌发生的危险因素;(4)体重指数与分化型甲状腺癌的关系:(1)体重每增加5Kg/m2罹患分化型甲状腺癌的风险随之增加,差异具有统计学意义(P=0.049);(2)体重指数与分化型甲状腺癌的恶性程度不具有一定相关性;(5)雌激素水平与分化型甲状腺癌的关系:1)对于女性患者:(1)雌激素水平175pmol/L时,患分化型甲状腺癌的比率占84.5%(432/511),雌激素水平≤175 pmol/L时,患分化型甲状腺癌的比率占64.6%(330/511),差异具有统计学意义(P0.05);(2)雌激素175 pmol/L的女性DTC患者淋巴结转移率44.4%(192/432),雌激素≤175pmol/L的女性DTC患者淋巴结转移率为33.9%(112/330),差异具有统计学意义(P0.05);(3)既往具有内分泌相关疾病病史(乳腺癌、乳腺纤维瘤、乳腺结节、子宫肌瘤、卵巢囊肿)的患者患分化型甲状腺癌的比率占83%(117/141),既往无内分泌相关疾病病史患分化型甲状腺癌的比率占73.2%(645/881),差异具有统计学意义(P0.05)。2)对于男性患者:(1)男性雌激素水平113 pmol/L患分化型甲状腺癌的比率占76.8%(86/112),雌激素113pmol/L发生占63.9%(69/108),差异具有统计学意义(P0.05)。结论(1)患者的年龄≤45岁、TSH2.11m U/L、BMI≥25Kg/m2是影响分化型甲状腺癌的危险因素,应予以重视;(2)随着体重指数的增加,患分化型甲状腺癌的风险增加,临床对于体重超标患者应予以重视;(3)体重指数与分化型甲状腺癌的恶性程度不具有一定相关性;(4)女性雌激素水平增高患分化型甲状腺癌的风险增大,同时更容易伴有淋巴结转移;(5)既往具有内分泌相关疾病病史的女性患分化型甲状腺癌的风险增加,同时证明雌激素水平的变化对分化型甲状腺癌的发生发展具有一定的影响;(6)男性患者雌激素水平增高,更容易患分化型甲状腺癌。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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