摘要
目的:探讨继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,sHPT)伴甲状腺乳头状癌(papillary thyroid cancer,PTC)患者的临床特征。方法:收集2017年4月—2020年12月因sHPT接受手术治疗的219例患者的资料。根据术后病理分为sHPT不伴PTC组与sHPT伴PTC组,比较sHPT伴PTC组与单纯PTC组之间的差异。根据年龄、性别和体质指数,选择同时期因甲状腺结节或甲状腺恶性肿瘤接受住院治疗的50例PTC患者,探讨sHPT与PTC之间的关联及其临床特征。结果:219例sHPT患者均接受甲状旁腺全切加自体移植(total parathyroidectomy with autotransplantation,tPTx+AT),其中男性102例、女性117例,平均年龄为(53.31±11.51)岁。logistic回归分析结果显示,腹膜透析[比值比:45.213(95%置信区间:1.501~28.648)]、血清钙水平较高[比值比:45.213(95%置信区间:1.978~1033.738)]、血清降钙素水平较低[比值比:0.817(95%置信区间:0.693~0.963)]和血清促甲状腺激素(thyroid stimulating hormone,TSH)水平较低[比值比:0.474(95%置信区间:0.247~0.912)]是sHPT伴PTC的危险因素。与单纯PTC患者相比,sHPT伴PTC患者的甲状腺功能略减退(FT3:P=0.006;FT4:P=0.008)、血清Tg和降钙素水平更高(Tg:P<0.001;降钙素:P<0.001)、血清25(OH)D水平更低(P<0.001)、血清ALP水平更高(P<0.001)以及双侧癌灶、多发癌灶(P=0.024)和Ⅵ区淋巴结转移(P=0.043)更多。结论:sHPT患者较正常人群更易发生甲状腺恶性肿瘤,并且肿瘤的侵袭性和转移性更强,因此对于sHPT伴甲状腺恶性肿瘤的患者应做到早发现、早诊断和早治疗。
Objective:To explore the clinical characteristics of secondary hyperparathyroidism(sHPT)with papillary thyroid cancer(PTC).Methods:The data of 219 patients undergoing surgical opertion for sHPT from April 2017to December 2020 were collected.According to postoperative pathology,the patients were divided into sHPT without PTC group and sHPT with PTC group.The differences between sHPT with PTC group and simple PTC group were compared.According to the age,gender and body mass index,50 patients with PTC who were hospitalized for thyroid nodules and thyroid malignant tumor at the same time were selected to explore the relationship between sHPT and PTC and the related clinical characteristics.Results:There were 219 patients with sHPT who received total parathyroidectomy with autotransplantation(tPTx+AT),including 102 males and 117 females,with an average age of(53.31±11.51)years.The results of logistic regression analysis showed that peritoneal dialysis[odds ratio:45.213(95%confidence interval:1.501-28.648)],high serum calcium level[odds ratio:45.213(95%confidence interval:1.978-1033.738)],low serum calcitonin level[odds ratio:0.817(95%confidence interval:0.693-0.963)]and low serum thyroid stimulating hormone(TSH)level[odds ratio:0.474(95%confidence interval:0.247-0.912)]were risk factors for sHPT with PTC.Compared with patients with PTC alone,patients with sHPT and PTC have slightly decreased thyroid function(FT3:P=0.006;FT4:P=0.008),higher serum Tg and calcitonin levels(Tg:P<0.001;calcitonin:P<0.001),lower serum25(OH)D level(P<0.001),higher serum ALP level(P<0.001),and more bilateral cancer lesions,multiple cancer lesions(P=0.024)and lymph node metastasis(P=0.043).Conclusion:Patients with sHPT are more prone to thyroid malignancies than normal controls,and the tumor is more invasive and metastatic.Therefore,early detection,diagnosis and treatment should be carried out for sHPT patients with thyroid malignancies.
作者
陈博婕
史苑
尹新璐
费梦嘉
王家东
徐雅男
CHEN Bojie;SHI Yuan;YIN Xinlu;FEI Mengjia;WANG Jiadong;XU Yanan(Department of Head and Neck Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200001,China)
出处
《肿瘤》
CAS
CSCD
北大核心
2022年第3期172-180,共9页
Tumor
