碘营养状况与结节性甲状腺肿及甲状腺乳头状癌相关关系研究

发布时间：2018-05-10 21:01

本文选题：血清碘 + 尿碘　；参考：《北京协和医学院》2017年硕士论文

【摘要】：背景:碘作为合成甲状腺激素的原料,是机体必需的微量元素。随着全民食盐加碘的进行,碘营养状况得到改善,碘缺乏病逐渐减少。而全民食盐加碘引起的碘过量和甲状腺疾病发病率增加之间的关系得到更多关注。目的:研究碘营养状况与结节性甲状腺肿及甲状腺乳头状癌之间的关系。资料与方法:收集北京协和医院2015年5月至2017年1月行手术治疗结节性甲状腺肿患者30例,甲状腺乳头状癌患者90例。所有患者术前行血清碘、尿碘、尿碘肌酐比值化验,术中留取正常甲状腺组织标本行组织碘含量检测。比较结节性甲状腺肿患者与甲状腺乳头状癌患者、甲状腺乳头状癌不同分期患者碘营养代谢各项指标有无差异。结果:(1)甲状腺乳头状癌组血清TSH浓度(1.991vs.1.218μIU/ml)、血清碘浓度(64vs.54ug/L)、组织碘含量(2035.77vs.759.43mg/kg)均高于结节性甲状腺肿组,差异有统计学意义(P值分别=0.033,=0.004,0.001);多因素回归分析显示血清碘、组织碘升高是甲状腺癌的独立危险因素。(2)甲状腺癌淋巴结转移癌组血清碘浓度(P=0.030)、组织碘含量(P=0.024)均高于未发生淋巴结转移组,差异有统计学意义。(3)甲状腺癌被膜侵犯组组织碘含量(P=0.031)高于未发生被膜侵犯组,差异有统计学意义。(4)54.44%(49/90)的甲状腺癌患者,尿碘处于碘充足量(MUI 100-199 μg/L)以上。(5)患者血清碘、尿碘、组织碘有相关性,皮尔逊相关性P0.05。结论:血清碘升高是甲状腺乳头状癌的独立危险因素,在甲状腺淋巴结转移患者中血清碘升高尤为明显。在甲状腺乳头状癌患者中,组织碘升高;发生淋巴结转移/甲状腺被膜侵犯病人,组织碘升高明显。在甲状腺乳头状癌与结节性甲状腺肿的比较中,未发现两者尿碘及尿碘肌酐比值存在显著性差异。在甲状腺乳头状癌患者中,促甲状腺激素释放激素升高。血清碘、尿碘、尿碘肌酐比值存在相关性。
[Abstract]:Background: iodine, as a raw material for the synthesis of thyroid hormones, is an essential trace element. With the development of universal salt iodization, iodine nutrition has been improved and iodine deficiency disorders have been gradually reduced. The relationship between iodine excess caused by universal salt iodization and increased incidence of thyroid disease has received more attention. Objective: to study the relationship between iodine nutrition and nodular goiter and papillary thyroid carcinoma. Materials and methods: from May 2015 to January 2017, 30 patients with nodular goiter and 90 patients with papillary thyroid carcinoma were collected. All patients were tested for serum iodine and urinary iodine creatinine ratio before operation. To compare the difference of iodine nutrition metabolism between patients with nodular goiter and patients with papillary thyroid carcinoma and patients with different stages of thyroid papillary carcinoma. Results the serum TSH concentration, serum iodine concentration and tissue iodine content in papillary thyroid carcinoma group were 1.991vs.1.218 渭 IUP / ml, 64vs.54ugP / L and 2035.77vs.759.43mg / kg, respectively. Tissue iodine elevation was an independent risk factor for thyroid carcinoma. (2) Serum iodine concentration and tissue iodine content in patients with lymph node metastasis were significantly higher than those without lymph node metastasis. The difference was statistically significant (P < 0.031) (P < 0.031) higher than that in the group without membrane invasion. The difference was statistically significant in thyroid cancer patients with thyroid cancer whose urine iodine was over 100 ~ 199 渭 g / L (MUI 100-199 渭 g 路L ~ (-1) in patients with thyroid cancer, and there was significant difference in serum iodine, urinary iodine, and urinary iodine in patients with thyroid cancer. Tissue iodine was correlated with Pearson correlation (P0.05). Conclusion: elevated serum iodine is an independent risk factor for thyroid papillary carcinoma, especially in patients with thyroid lymph node metastasis. In patients with papillary thyroid carcinoma, tissue iodine was increased, and in patients with lymph node metastasis / thyroid membrane invasion, tissue iodine increased significantly. There was no significant difference in urinary iodine and urinary iodine creatinine ratio between papillary thyroid carcinoma and nodular goiter. Thyroid hormone releasing hormone (TSH) is elevated in patients with papillary thyroid carcinoma. There was a correlation between serum iodine and urinary iodine creatinine ratio.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1;R581.3

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