代谢综合征及其组分与复发甲状腺乳头状癌相关性研究

发布时间：2018-06-09 20:22

本文选题：代谢综合征 + 甲状腺乳头状癌　；参考：《郑州大学》2017年硕士论文

【摘要】：背景及目的代谢综合征(metabolic syndrome,Met S)是由几种常见的营养代谢紊乱所组成,这些营养代谢紊乱,例如糖代谢异常、脂肪代谢紊乱等,呈现一种症状聚集的现象,相关疾病包括肥胖,特别是是中心性肥胖,糖尿病,高胰岛素血证,高血压,高血脂等。近年来,代谢综合征的发病率逐年上升,已经成为主要威胁公共健康的疾病之一。代谢综合征的一个显著特点即它可以通过改变生活习惯而使疾病得到控制,甚至在早期即可以恢复正常。不同地区的卫生组织对代谢综合征的定义有差异。但无论代谢综合征的定义如何不同,均公认为胰岛素抵抗(Insulin Resistance,IR)为其发病的主要环节。胰岛素是由胰腺B细胞分泌的一种有强大的调节细胞糖代谢能力的内分泌激素,是代谢综合征影响恶性肿瘤发生发展的主要机制之一,也是代谢综合征相关组分发病机制的共同环节。越来越多的研究表明,代谢综合征与多种恶性肿瘤的发生发展相关。其组成代谢紊乱尤以糖代谢异常和肥胖这两种组分对癌症的影响为明显。甲状腺癌发病率的增加,其主要成分是癌灶直径小于1cm的甲状腺微小乳头状癌的发病率增加。发病率的增加与甲状腺癌的检出率增高有关。但是,甲状腺癌检出率的增高并不能充分的解释甲状腺癌患病率的增高。有其他原因导致了甲状腺癌的发病率的增加。甲状腺乳头状癌是甲状腺癌最长见的病理类型。近年来有研究发现,超重或肥胖对甲状腺癌发病率的升高起到一定作用。除此之外,糖尿病也被认为与甲状腺癌的发病率增高有关。其他组分如高血压和血脂异常与甲状腺癌的相关研究较少。然而,代谢综合征对甲状腺癌复发的影响尚不清楚。胰岛素抵抗是代谢综合征的中心环节,2015年一项研究发现胰岛素抵抗会增加甲状腺乳头状癌的复发率。但二者的相关性仍需进一步的研究。为此,本研究搜集了郑州大学第一附属医院2010年至2016年的复发甲状腺乳头状癌患者资料,分析代谢综合征及其组分与复发甲状腺乳头状癌的关系。方法回顾性分析郑州大学第一附属医院2010年1月1日至2016年12月31日甲状腺外科收治的复发甲状腺乳头状癌患者。对照组同样选取2010至2016年就诊于郑州大学第一附属医院的手术患者。本研究主要通过两个方面分析代谢综合征与甲状腺乳头状癌的关系:(1)观察分析伴或不伴代谢综合征的复发甲状腺乳头状癌的临床特点:将资料依据是否合代谢综合征并分为两组,比较伴有代谢综合征复发组与不伴代谢综合征复发组在结节分级、大小、淋巴结转移分区、复发时间及浸润机率之间的差异。我们也分析了单一组分以及同时合并两种以上代谢综合征组分时的复发特点差异;(2)观察分析代谢综合征及其组分对甲状腺乳头状癌复发的影响:比较复发甲状腺乳头状癌组与对照组即未复发组同时合并代谢综合征情况的差异以及其代谢异常组分包括糖尿病、高血压、血脂代谢异常、肥胖或超重的差异。SPSS 23.0软件行统计分析。对于正态分布的定量资料并方差齐的用t检验,非正态分布或方差不齐的定量资料及等级资料用秩和检验,分类资料用χ2检验。多因素回归分析用logistics回归分析,分析方法为逐步法。以P0.05为差异有统计学意义。结果117例复发患者初次就诊时大多无明显症状。36例合并有代谢综合征,占同期复发患者的30.77%(36/117)。通过比较伴或不伴代谢异常的复发甲状腺乳头状癌的临床特点发现低中危复发危险度组伴有代谢综合征的女性占44.90%(22/49),男性占16.67%(6/36),女性合并代谢综合征的比例较男性多(P=0.01)。无代谢综合征组淋巴结转移率为68.42%(39/57),但是两组的淋巴结转移区域差异有统计学意义(p=0.017)。高危组伴与不伴代谢综合征组的年龄、性别、原发灶大小、淋巴结转移率无统计学差异。低中危组患者合并任意一种以上代谢综合征的百分比为87.06%、高危组59.37%,低中危组大于高危组,差异有统计学意义(P=0.001)。伴有血脂异常的甲状腺乳头状癌患者的复发时间明显短于血脂正常的患者(P=0.001);同样,BMI≥25kg/m2的超重或肥胖的患者复发时间明显短于体重正常的患者(P=0.001)。通过与未复发组比较发现复发组代谢综合征及其组分的患病率明显高于对照组。多因素回归分析提示肿瘤直径越大,甲状腺乳头状癌越容易复发(P=0.000),肿瘤直径与复发甲状腺乳头状癌的优势比(OR值)为1.91,95%置信区间(95%CI)为1.37-2.66;原发病灶位于双侧叶的甲状腺乳头状癌较病灶局限于单侧腺叶的易复发(P=0.000),其OR值为4.68,95%CI为2.01-10.88;在代谢异常方面,BMI≥25kg/m2的超重或肥胖患者的比体重正常的患者容易复发(P=0.000),其OR值为8.12,95%CI为3.58-18.45;代谢综合征与甲状腺乳头状癌的复发率增加有关(P=0.042),其OR值为2.67,95%CI为1.04-6.88。结论代谢综合征及其组分包括糖尿病、高血压、超重或肥胖以及血脂异常提高了本身术后评估良好的甲状腺乳头状癌的复发率,超重或肥胖和异常脂代谢可以加速甲状腺乳头状癌的发展而缩短了复发时间。而癌灶直径,单双叶发病,超重或肥胖和代谢综合征是甲状腺乳头状癌复发的独立影响因素。因此对于伴有代谢异常尤其是肥胖的甲状腺乳头状癌的患者,合理扩大清扫范围,术后严格随访,必要时增加随访的频率。当然,无论是对于合并代谢紊乱的甲状腺乳头状癌患者临床治疗方案还是疾病的发展机制,都有待于进一步的研究。
[Abstract]:Background and objective metabolic syndrome (Met S) is composed of several common metabolic disorders, such as abnormal metabolism of sugar, disorder of fat metabolism, and a phenomenon of aggregation of symptoms, related diseases including obesity, especially central obesity, diabetes, high insulin blood syndrome, high blood pressure. In recent years, the incidence of metabolic syndrome has increased year by year, and it has become one of the main threats to public health. A significant feature of the metabolic syndrome is that it can control the disease by changing the living habits, even in the early days. There are differences in definition. However, regardless of the definition of metabolic syndrome, it is recognized that Insulin Resistance (IR) is the main link of its pathogenesis. Insulin is a powerful endocrine hormone secreted by B cells of the pancreas, which regulates the metabolic capacity of cell sugar. It is the main effect of metabolic syndrome on the development of malignant tumors. One of the mechanisms is also a common link in the pathogenesis of metabolic syndrome related components. More and more studies have shown that metabolic syndrome is associated with the development of a variety of malignant tumors. The metabolic disorders are especially evident in the two components of glucose metabolism and obesity. The increase of the incidence of thyroid cancer is the main result. The increase in the incidence of thyroid small papillary carcinoma is associated with an increase in the incidence of thyroid cancer. However, the increase in the detection rate of thyroid cancer is not sufficient to explain the increase in the incidence of thyroid cancer. Other reasons lead to the increase in the incidence of thyroid adenocarcinoma. Thyroid papillae have increased. Cancer is the most common pathological type of thyroid cancer. Recent studies have found that overweight or obesity plays a role in the rise of thyroid cancer. In addition, diabetes is also considered to be associated with a higher incidence of thyroid cancer. Other components, such as hypertension and dyslipidemia, are less related to thyroid cancer. The effect of the Xie syndrome on the recurrence of thyroid cancer is not clear. Insulin resistance is the central link of the metabolic syndrome. A study in 2015 found that insulin resistance increased the recurrence rate of thyroid papillary carcinoma. However, the correlation between the two remains to be further studied. Therefore, this study collected the first Affiliated Hospital of Zhengzhou University from 2010 to 2. 016 years of recurrent thyroid papillary carcinoma data, analysis of the relationship between metabolic syndrome and its components and recurrent thyroid papillary carcinoma. Methods Retrospective analysis of recurrent thyroid papillary carcinoma admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2010 to December 31, 2016. The control group was also selected from 2010 to 2016. This study examined the relationship between metabolic syndrome and papillary thyroid carcinoma in two aspects: (1) observe and analyze the clinical characteristics of recurrent thyroid papillary carcinoma with or without metabolic syndrome: the data are divided into two groups according to whether the syndrome is combined with the metabolic syndrome, and the comparative companion is compared. Differences in nodular classification, size, lymph node metastases, recurrence time and invasive probability were found in recurrent and non metabolic syndrome groups in recurrent and non metabolic syndrome groups. We also analyzed the difference of recurrent characteristics between the single component and the simultaneous combination of more than two types of metabolic syndrome; (2) observation and analysis of metabolic syndrome and its component pairs The effect of recurrence of thyroid papillary carcinoma: comparison of the difference of concurrent metabolic syndrome in the recurrent thyroid papillary carcinoma group and the control group, that is, the non recurrent group, and the difference of the metabolic abnormalities including diabetes, hypertension, dyslipidemia, and the difference of obesity or overweight.SPSS 23 software. The quantitative analysis of the normal distribution T test was used to test the data and variance. The quantitative data and grade data of non normal distribution or variance were tested with rank sum test, the classification data were tested by chi 2. Multiple factor regression analysis was analyzed by logistics regression analysis, and the analysis method was stepwise method. The difference of P0.05 was statistically significant. Most of the 117 cases of recurrent patients had no obvious symptoms at first visit. .36 cases were combined with metabolic syndrome, which accounted for 30.77% (36/117) of the recurrent patients in the same period. By comparing the clinical characteristics of recurrent thyroid papillary carcinoma with or without metabolic abnormalities, 44.90% (22/49), 16.67% (6/36) for men with metabolic syndrome were found in the group with low risk of recurrence and 16.67% (6/36), and the proportion of women with metabolic syndrome was more than that of men. The lymph node metastasis rate in the non metabolic syndrome group was 68.42% (39/57), but there was significant difference in the lymph node metastases in the two groups (p=0.017). There was no statistical difference in the age, sex, size of primary focus and lymph node metastasis in the high risk group with the non metabolic syndrome group. The percentage of the syndrome was 87.06%, the high risk group was 59.37%, the low medium risk group was larger than the high risk group, the difference was statistically significant (P=0.001). The recurrence time of the thyroid papillary carcinoma with abnormal blood lipid was significantly shorter than that of the normal blood lipid (P=0.001); similarly, the recurrence time of the overweight or obese patients with BMI > 25kg/m2 was significantly shorter than that of the normal weight. The incidence of metabolic syndrome and its components in the recurrent group was significantly higher than that in the non recurrent group (P=0.001). Multiple factor regression analysis suggested that the greater the diameter of the tumor, the more prone the thyroid papillary carcinoma relapsed (P=0.000), and the ratio of the tumor diameter to the recurrence of thyroid papillary carcinoma (OR) was the confidence interval of 1.91,95%. 95%CI) is 1.37-2.66; the thyroid papillary carcinoma of the primary lesion is located in the bilateral lobe of the thyroid papillary carcinoma, which is limited to the unilateral lobe of Yi Fufa (P=0.000), and its OR value is 4.68,95%CI 2.01-10.88; in metabolic abnormalities, the overweight or obese patients with BMI > 25kg/m2 are more likely to relapse than those with normal weight (P=0.000), and the OR value is 8.12,95%CI 3.58-18.45. Metabolic syndrome is associated with an increase in the recurrence rate of papillary thyroid carcinoma (P=0.042), and its OR value is 2.67,95%CI 1.04-6.88. conclusion metabolic syndrome and its components, including diabetes, hypertension, overweight or obesity, and dyslipidemia, increase the recurrence rate of thyroid papillary carcinoma, overweight or obesity, and abnormal fat. Metabolism can accelerate the development of thyroid papillary carcinoma and shorten the time of recurrence. The diameter of the cancer, the onset of mono lobar, overweight or obesity and metabolic syndrome are independent factors for the recurrence of thyroid papillary carcinoma. Follow up strictly and increase the frequency of follow-up when necessary. Of course, further research is needed, whether the clinical treatment scheme for the patients with thyroid papillary carcinoma and the mechanism of the disease.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589;R736.1

【相似文献】