摘要
目的探讨甲状腺乳头状癌(PTC)和结节性甲状腺肿病人尿碘和血清中促甲状腺激素(TSH)水平的变化及其相关性。方法 2016年8月—2017年3月,我院确诊为PTC病人514例(PTC组),结节性甲状腺肿病人468例(结甲组)。分别检测两组病人晨尿中碘含量、血清中TSH水平及其他临床指标,应用SPSS 23.0、Empower stats及R studio进行统计处理。结果与结甲组比较,PTC组病人尿碘及血清中TSH水平均较高,差异有显著性(P<0.05)。校正混杂因素后,阈值分析结果显示,两组的尿碘与TSH水平之间均呈U形曲线关系。在PTC组的U形曲线上尿碘浓度变化存在两个转折点,分别为210、672μg/L,而结甲组仅有一个转折点,为397μg/L。在PTC组,当尿碘浓度<210μg/L时,TSH水平随尿碘增高而降低(β=-0.008,P<0.05);当尿碘浓度为210~672μg/L时,TSH水平随尿碘水平的增高而持续升高(β=0.003,P<0.05);当尿碘浓度>672μg/L时,TSH水平变化不显著(β=-0.004,P>0.05)。而在结甲组,在尿碘浓度397μg/L前后,TSH水平随尿碘的升高呈现先下降(β=-0.009,P<0.05)后增高(β=0.004,P<0.05)的趋势。结论 PTC病人的TSH水平对于尿碘浓度的变化更为敏感。但PTC病人尿碘值>210μg/L时,结甲病人尿碘值>397μg/L时,应注意碘浓度对TSH的刺激作用。
Objective To investigate the changes in urinary iodine and serum thyroid stimulating hormone（ TSH） level and the correlation between them in patients with papillary thyroid carcinoma（ PTC） or nodular goiter. Methods A total of 514 patients with PTC（ PTC group） and 468 patients with nodular goiter（ nodular group） who were diagnosed in our hospital from August 2016 to March 2017 were enrolled in this study. The content of iodine in morning urine,serum TSH level,and several other clinical indices were measured for both groups,and SPSS 23.0,Empower stats,and R studio were used for statistical analysis. Results Compared with the nodular group,the PTC group had significant increases in urinary iodine and serum TSH level（ P〈0.05）. After adjustment for confounding factors,the threshold analysis showed a U-shaped correlation between urinary iodine and TSH level in both groups. The PTC group had two turning points（ 210μg/L and 672 μg/L） in the concentration curve of urinary iodine,while the nodular group only had one turning point（ 397 μg/L）. In the PTC group,when urinary iodine was 210 μg/L,TSH level decreased with the increase in urinary iodine（ β =-0.008,P〈0.05）; when urinary iodine ranged from 210 to 672 μg/L,TSH level increased with the increase in urinary iodine（ β = 0.003,P〈0.05）; when urinary iodine was 672 μg/L,there was no significant change in TSH level（ β =-0.004,P〈0.05）. In nodular group,when urinary iodine was around397 μg/L,TSH level decreased at first（ β =-0.009,P〈0.05） and then increased（ β = 0.004,P〈0.05）. Conclusion TSH level in patients with PTC is more sensitive to the change in urinary iodine than that in patients with nodular goiter. However,when urinary iodine of PTC patients is higher than 210 μg/L or urinary iodine of patients with nodular goiter is higher than 397 μg/L,we should pay attention to the stimulating effect of iodine concentration on TSH secretion.
作者
辛燕璐
张伟
朱绪华
迟静薇
王彦
王颜刚
赵世华
XIN Yanlu, ZHANG Wei, ZHU Xuhua, CHI Jingwei, WANG Yan, WANG Yangang, ZHAO Shihua(Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao 266003, Chin)
出处
《精准医学杂志》
2018年第3期270-273,共4页
Journal of Precision Medicine
基金
山东省自然科学基金面上项目(ZR2016HM29)
