甲状腺乳头状癌合并桥本氏甲状腺炎的中医证候与病理特征分析

Analysis of traditional Chinese medicine syndromes and pathological characteristics of thyroid papillary carcinoma with Hashimoto's thyroiditis

关键词:  甲状腺乳头状癌  桥本氏甲状腺炎  病理特征  中医证型

Key words:  thyroid papillary carcinoma  Hashimoto's thyroiditis  pathological characteristics  traditional Chinese medicine syndrome type

摘要:

[目的] 探讨合并桥本氏甲状腺炎（HT）对甲状腺乳头状癌（PTC）患者的中医证型分布和临床病理特征的影响。[方法] 回顾性分析中日友好医院 2020 年 1 月—2022 年 1 月符合纳排标准的因甲状腺乳头状癌行手术治疗的379 例患者病历资料。观察指标包含性别、年龄、中医四诊信息、有无 HT、BRAF V600E 基因、肿瘤最大直径、累及腺叶、被膜侵犯、肿瘤个数、是否微小癌、颈部淋巴结转移。根据患者病理结果是否合并 HT 将患者分为观察组（即合并HT 的 PTC 患者）146 例和对照组（即不合并 HT 的 PTC 患者）233 例。采用 SPSS 25.0 统计软件进行分析。[结果] 与对照组比较，观察组肝郁气滞证型和脾肾阳虚证比例更高（P＜0.05）、气阴两虚证和气血两虚比例更低（P＜0.05）。两组痰瘀互结、瘀热伤阴证分布差异无统计学意义。与对照组相比，观察组女性比例更高、肿瘤直径更小、多灶性比例更高、颈部淋巴结转移比例更低（P＜0.05）。而两组间 BRAF V600E 基因表达、累及腺叶范围、是否为微小癌、被膜侵犯等差异无统计学意义。TPOAb 抗体阳性与肿瘤直径较小、低 BRAF V600E 基因突变率和低颈部淋巴结转移率相关（P＜0.05）。TGAb 抗体阳性亦与肿瘤直径较小相关（P＜0.05），而与其他病理特征无显著相关性。中医证型与肿瘤病理特征相关分析提示 PTC 患者脾肾阳虚证与肿瘤分期高相关（P＜0.05）。试验组痰瘀互结证与复发风险高相关（P＜0.05）。尚未发现观察组中医证型与病理特征的显著相关性；对照组其气阴两虚证与肿瘤多灶性相关（P＜0.05）。[结论] 合并 HT的 PTC 患者肝郁气滞和脾肾阳虚证型比例更高， 气阴两虚和气血两虚证型比例更低。中医证型可能与临床病理特征、肿瘤分期与复发风险相关。合并 HT 的 PTC 患者女性居多，肿瘤多灶性比例高，但具肿瘤体积小、颈淋巴结转移低等有利特征，抗甲状腺抗体阳性是其主要相关因素。

Abstract:

[Objective] To explore the effect of Hashimoto’s thyroiditis （HT） on the distribution of traditional Chinese medicine（TCM） syndromes and clinicopathological characteristics of thyroid papillary carcinoma（PTC） patients. [Methods] The medical records of 379 patients with thyroid papillary carcinoma who met the standard of Nabil from January 2020 to January 2022 in the China-Japan Friendship Hospital were analyzed retrospectively. The observation indicators include gender，age，four diagnostic information of traditional Chinese medicine，whether there is HT，BRAF V600E gene，the largest diameter of tumor，gland lobe involved，capsule invasion，number of tumor，whether there is microcancer，and cervical lymph node metastasis. According to the pathological results of the patients，they were divided into an observation group （i.e. PTC patients with HT） of 146 cases and a control group （i.e. PTC patients without HT） of 233 cases. SPSS 25.0 statistical software was used for analysis. [Results] Compared with control group，observation group had a higher proportion of liver stagnation and qi stagnation syndrome and spleen and kidney yang deficiency syndrome （P＜0.05），and the proportion of deficiency of both qi and yin and deficiency of both qi and blood was lower（P＜0.05）. There was no statistical difference between the two groups in the distribution of phlegm and blood stasis and yin syndrome caused by blood stasis and heat. Compared with control group，observation group had a higher proportion of women，a smaller tumor diameter，a higher proportion of multifocal lesions， and a lower proportion of cervical lymph node metastasis（P＜0.05）. However，there was no statistical difference between the two groups in the expression of BRAF V600E gene，the extent of gland lobe involved，whether it was microcarcinoma，and the invasion of capsule. Positive TPOAb antibody was associated with small tumor diameter，low BRAF V600E gene mutation rate and low cervical lymph node metastasis rate （P＜0.05）. Positive TGAb antibody was also associated with smaller tumor diameter （P＜0.05）. There was no significant correlation between TGAb positive and other pathological features. The correlation analysis between TCM syndrome types and tumor pathological characteristics showed that the spleen and kidney yang deficiency syndrome in PTC patients was highly correlated with tumor stage （P＜0.05）. Observation group was associated with high risk of recurrence （P＜0.05）. No significant correlation between TCM syndrome types and pathological characteristics of observation group has been found. The syndrome of deficiency of both qi and yin in control group was related to the multifocal tumor （P＜0.05）. [Conclusion] PTC patients with HT had a higher proportion of liver depression and qi stagnation，spleen and kidney yang deficiency syndrome types，and a lower proportion of qi yin deficiency and qi blood deficiency syndrome types. TCM syndrome types may be related to clinicopathological characteristics，tumor stage and recurrence risk. The majority of PTC patients with HT are women，and the proportion of tumor multifocal is high，but it has the advantages of small tumor size and low cervical lymph node metastasis，and the positive anti-thyroid antibody is the main related factor.