分化型甲状腺癌合并桥本甲状腺炎患者血清TgAb水平检测的临床价值

目的 分析经手术+131I清甲治疗后血清甲状腺球蛋白抗体（TgAb）阳性且合并桥本甲状腺炎（HT）的分化型甲状腺癌（DTC）患者的预后，并观察TgAb水平的变化及其与预后的关系。 方法 对2013年5月至2016年10月本院收治的141例经手术+131I治疗后血清TgAb阳性（>115 IU/mL）的DTC患者进行回顾性分析，其中男性14例、女性127例，年龄15~74（40.86±11.21）岁。根据DTC患者是否合并HT分为DTC合并HT组（G1组，n=49）和DTC不合并HT组（G2组，n=92）。比较2组在疾病持续或复发率方面有无差异，同时分析TgAb水平变化及其与疾病预后的关系。DTC患者中位随访时间为22（12~56）个月。2组间预后评估及TgAb趋势分析采用χ2检验或Fisher确切概率法；不同组间TgAb水平及其变化差异采用Mann-Whitney U秩和检验。 结果 G1组患者年龄比G2组小，且差异有统计学意义（t=?2.275，P=0.026），其他临床及病理资料均无统计学意义。G1组患者疾病持续或复发率（3/49，6.12%）明显低于G2组（20/92，21.74%），且差异有统计学意义（χ2=5.712，P=0.017）。G1组患者手术+131I治疗前后TgAb水平呈下降趋势的比例（46/49，93.88%）明显高于G2组（60/92，65.22%），且差异有统计学意义（χ2=14.073，P<0.001）。G1组患者中TgAb水平下降的疾病持续或复发率（1/46，2.17%）低于TgAb水平持续或上升（2/3，66.67%），差异有统计学意义（Fisher检验无检验值，P=0.008）；G2组患者中TgAb水平下降的疾病持续或复发率（4/60，6.67%）低于TgAb水平持续或上升（16/32，50.00%），差异有统计学意义（χ2=23.034，P=0.000）。G1组术前TgAb水平、手术+131I治疗前后TgAb下降水平及下降率均大于G2组（558.70 IU/mL vs. 352.35 IU/mL，398.09 IU/mL vs. 124.84 IU/mL，85.15% vs. 41.43%），差异均有统计学意义（U=1581.00、1210.00、1113.00，均P<0.05）。 结论 手术+131I清甲治疗后血清TgAb阳性且合并HT的DTC患者的预后较好，TgAb水平的变化趋势可作为DTC患者疾病预后的监测指标。

Clinical value of serum TgAb test in patients with differentiated thyroid carcinoma coexistent with Hashimoto thyroiditis

Objective To analyze the prognosis of patients with positive serum thyroglobulin antibody(TgAb) in the papillary thyroid carcinoma(DTC) coexistent with Hashimoto's thyroiditis(HT) after thyroidectomy + 131I ablation and observe the change in TgAb and its association with the prognosis. Methods A retrospective analysis was performed on 141 patients with DTC possessing positive serum TgAb (>115 IU/mL) that were admitted to our hospital from May 2013 to October 2016 after surgical +131I treatment, including 14 males and 127 females aged 15?74(40.86±11.21). Patients were divided into DTC with HT (G1 group, n=49) and DTC without HT groups(G2 group, n=92) according to the presense of concurrent HT or not. The disease duration or recurrence rates between the two groups were compared. The changes in TgAb level and its relationship with prognosis were also analyzed. The median follow-up of patients with DTC was 22 months(12?56 months). Prognostic assessment and TgAb trend analysis between the two groups were performed by χ2 test or Fisher exact probability method. The difference in TgAb levels between different groups was tested by Mann-Whitney U rank sum test. Results The age of the patients in the G1 group was lower than that in the G2 group, and the difference was statistically significant. Other clinical and pathological data were statistically in significant. The disease duration or recurrence rate in patients in the G1 group(3/49, 6.12%) was significantly lower than that in the G2 group(20/92, 21.74%, χ2=5.712, P=0.017). The TgAb proportion showed a declining trend before and after surgery +131I in the G1 group(46/49, 93.88%), which was significantly higher than that in G2 group(60/92, 65.22%, χ2=14.073, P< 0.001). In the G1 group, the disease persistence or recurrence rate of TgAb level decreased (1/46, 2.17%) was lower than that of TgAb sustained or increased(2/3, 66.67%, Fisher's test P=0.008). The disease persistence or recurrence rate of TgAb decreased in the patients in the the G2 group(4/60, 6.67%) and was lower than that of TgAb sustained or increased (16/32, 50.00%, χ2=23.034, P=0.000). The TgAb value level of preoperative, and the changes in values and rates of TgAb before and after thyroidectomy + 131I ablation in the G1 group(558.70 IU/mL, 398.09 IU/mL, and 85.15%) were greater than those in the G2 group(352.35 IU/mL, 124.84 IU/mL, and 41.43%), and the differences were statistically significant(U=1581.00, 1210.00 and 1113.00, all P<0.05). Conclusion Among the patients with DTC having positive serum TgAb after thyroidectomy + 131I ablation, the patients with coexistented HT had improved prognosis, and the change in trend of TgAb can be used as an indicator in monitoring the prognosis of patients with DTC.