范岭　慕腾　石国豪

【摘要】 目的：明確HT与PTC在临床上的关联，并在此基础上进一步探讨合并HT对PTC预后的影响。方法：收集2000-2015年在丰台医院行甲状腺手术，病理确诊PTC且具有术前血清标本的病例共269例。比较所有研究对象包括性别、年龄、病程、手术方式、肿瘤大小、浸润范围及淋巴结侵袭等在内的临床、组织病理学特点。通过电化学发光法检测患者的血清促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）及甲状腺球蛋白抗体（TgAb）的水平。结果：269例PTC患者中有单纯PTC患者211例，HT合并PTC患者58例（21.6%）。HT合并PTC患者住院时间为（5.2±2.5）d，明显短于单纯PTC患者的（7.4±5.4）d，差异有统计学意义（P=0.001）。HT合并PTC组患者中接受中央淋巴结清扫者13例（22.4%），单纯PTC组患者中接受中央淋巴结清扫者23例（10.9%），差异有统计学意义（P=0.029）。血清学方面，HT合并PTC组患者的术前血清TgAb、TPOAb浓度的中位数及TSH水平的均值均显著高于单纯PTC组，差异有统计学意义（P<0.001）。此外，HT合并PTC组患者的肿瘤平均直径为（1.3±0.7）cm，显著小于单纯PTC组患者的（2.3±1.0）cm，差异有统计学意义（P<0.001）。HT合并PTC组患者甲状腺外浸润的比例也显著低于单纯PTC组患者，差异有统计学意义（P=0.002）。结论：PTC患者合并HT发生率较高，HT基础上发生的PTC预后可能更好。

【关键词】 桥本甲状腺炎； 甲状腺乳头状癌； 预后

doi：10.14033/j.cnki.cfmr.2017.18.003 文献标识码 A 文章编号 1674-6805（2017）18-0006-03

The Effect of Concurrent Hashimotos Thyroiditis on the Prognosis of Papillary Thyroid Cancer/FAN Ling，MU Teng，SHI Guo-hao.//Chinese and Foreign Medical Research，2017，15（18）：6-8

【Abstract】 Objective：To investigate the relationship between HT and PTC and to explore the effect of concurrent Hashimotos thyroiditis on the prognosis of papillary thyroid cancer.Method：269 patients with thyroid surgery and histologically confirmed PTC in Fengtai Hospital from 2000-2015 were analyzed according to the presence or absence of HT.Patients clinical and histopathological characteristics including gender，age，duration，surgical procedure，tumor size，infiltration range and lymph node attack were collected.Serum levels of TSH，TgAb and TPOAb were tested by electrochemiluminescence.Result：Of the 269 patients with PTC，21.6%（58/269） had HT. The duration of hospital stay was significantly shorter in PTC patients with HT than PTC alone patients[（5.2±2.5）d vs （7.4±5.4）d，P=0.001].In terms of the neck dissection，central neck dissection（CND） without lateral neck dissection was more frequently performed in patients with PTC and HT than in patients with PTC alone （22.4% vs 10.9%），the difference was statistically significant（P=0.029）.Serologically，the levels of TgAb，TPOAb and TSH were significantly higher in the HT with PTC group than those in the PTC alone group，the differences were statistically significant（P<0.001）.In addition，the average tumor diameter of 58 HT with PTC patients was （1.3±0.7）cm，whereas of 211 PTC alone patients，the diameter was （2.3±1.0）cm，the difference was statistically significant（P<0.001）.The proportion of perithyroidal extension in the HT with PTC group was lower than that observed for the PTC alone group，the difference was statistically significant（P=0.002）.Conclusion：The incidence rate of PTC patients combined with HT is high.The prognosis of PTC on the basis of HT may be much better.endprint

【Key words】 Hashimotos thyroiditis； Papillary thyroid cancer； Prognosis

First-authors address：Fengtai Hospital of Beijing，Beijing 100071，China

桥本甲状腺炎（Hashimoto s thyroiditis，HT）是常见的器官特异性自身免疫性疾病，发病率约为0.3%～1.5%，女性发病率是男性的5～10倍[1-2]。甲状腺球蛋白抗体（thyroglobulin antibody，TgAb）和甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）是其标志性抗体[1-3]。甲状腺癌是较常见的恶性肿瘤，其中甲状腺乳头状癌（papillary thyroid carcinoma，PTC）最为常见。近年来HT合并PTC的发病率呈上升趋势，越来越受到临床医师的关注，本研究拟明确HT与PTC的临床关联，并在此基础上进一步探讨HT对PTC预后的影响。

1 资料与方法

1.1 一般资料

收集2000-2015年在丰台医院行甲状腺手术，病理确诊PTC的具有术前血清标本的病例共269例。……