CAJ | 학술논문

目的：探讨甲状腺球蛋白（Tg）及甲状腺球蛋白抗体（Tg-Ab）在甲状腺乳头状癌术后促甲状腺素抑制状态下随访中判断淋巴结转移的意义。方法随访2010年6月至2013年5月在中山大学孙逸仙纪念医院甲状腺外科就诊并经病理证实的甲状腺乳头状癌患者，按入选标准分两组，A组：发生淋巴转移组；B组：未发生淋巴转移组。检测两组患者血清中的Tg及Tg-Ab，转移淋巴的分区及数量。结果共有符合纳入标准患者1049例，其中发生淋巴转移的A组113例（10.8%），未发生淋巴转移的B组936例（89.2%）。两组患者的平均年龄、性别构成、淋巴转移发生的时间及初次术后的分期均基本相同，无统计学差异意义（P＞0.05）。A组患者Tg或TgAb阳性表达率为95.58%，显著高于B组的1.28%，有统计学差异意义（P＜0.05）；A组患者Tg阳性的表达率为49.56%，显著高于B组的0.53%（P＜0.05）；A组患者TgAb阳性的表达率为41.59%，显著高于B组的0.75%（P＜0.05）；Tg表达阳性的患者中，90.77%发淋巴转移，TgAb阳性的患者中88%发生淋巴转移，Tg及TgAb表达均为阴性的患者中只有0.54%发生淋巴转移（P＜0.05）。TgAb或Tg表达阳性的患者淋巴转移数为8.3±0.7，显著高于对TgAb和Tg表达均为阴性的3.2±0.5，有统计学差异意义（P＜0.05）。发生淋巴转移的患者随访6、12、18、24个月TgAb及Tg的阳性表达率分别为22.12%、23.89%、24.78%、24.78%，没有统计学差异意义（P＞0.05）。N1A期淋巴转移的患者TgAb或Tg表达率为94.64%%，N1B期为96.49%，没有统计学差异意义（P＞0.05）。结论 Tg或Tg-Ab阳性表达均提示甲状腺乳头状癌术后发生淋巴转移的可能，联合检测Tg 及Tg-Ab更有利于淋巴转移发生的诊断，Tg 及Tg-Ab阳性表达率与转移淋巴数量有关，与淋巴的分区及发生时间无关。
목적：탐토갑상선구단백（Tg）급갑상선구단백항체（Tg-Ab）재갑상선유두상암술후촉갑상선소억제상태하수방중판단림파결전이적의의。방법수방2010년6월지2013년5월재중산대학손일선기념의원갑상선외과취진병경병리증실적갑상선유두상암환자，안입선표준분량조，A조：발생림파전이조；B조：미발생림파전이조。검측량조환자혈청중적Tg급Tg-Ab，전이림파적분구급수량。결과공유부합납입표준환자1049례，기중발생림파전이적A조113례（10.8%），미발생림파전이적B조936례（89.2%）。량조환자적평균년령、성별구성、림파전이발생적시간급초차술후적분기균기본상동，무통계학차이의의（P＞0.05）。A조환자Tg혹TgAb양성표체솔위95.58%，현저고우B조적1.28%，유통계학차이의의（P＜0.05）；A조환자Tg양성적표체솔위49.56%，현저고우B조적0.53%（P＜0.05）；A조환자TgAb양성적표체솔위41.59%，현저고우B조적0.75%（P＜0.05）；Tg표체양성적환자중，90.77%발림파전이，TgAb양성적환자중88%발생림파전이，Tg급TgAb표체균위음성적환자중지유0.54%발생림파전이（P＜0.05）。TgAb혹Tg표체양성적환자림파전이수위8.3±0.7，현저고우대TgAb화Tg표체균위음성적3.2±0.5，유통계학차이의의（P＜0.05）。발생림파전이적환자수방6、12、18、24개월TgAb급Tg적양성표체솔분별위22.12%、23.89%、24.78%、24.78%，몰유통계학차이의의（P＞0.05）。N1A기림파전이적환자TgAb혹Tg표체솔위94.64%%，N1B기위96.49%，몰유통계학차이의의（P＞0.05）。결론 Tg혹Tg-Ab양성표체균제시갑상선유두상암술후발생림파전이적가능，연합검측Tg 급Tg-Ab경유리우림파전이발생적진단，Tg 급Tg-Ab양성표체솔여전이림파수량유관，여림파적분구급발생시간무관。
Objective To investigate the role of Tg and Tg-Ab expression in metastases of lymph nodes of post-operated PTC patients of TSH inhibited by thyroid hormone.Methods According metastases of neck nodes or not of the post-operated patients of Sun Yat-sen memorial hospital from in June of 2010 to in may in 2013 the patients were divided into two groups, groups A: with lymph metastasis; groups B: without lymph metastasis.Results Followed 6-36M,1049 patients met inclusion criteria , which 113(10.8%) in groups A and 936(89.2%)in groups B. age /sex ratio / average time of first operation and stage of tumor after first operation is similar in two groups, There was no any significantly difference(P>0.05).expression of Tg or Tg-Ab in groups A(95.58%) is much higher than in groups B(1.28%), which has significantly difference(P<0.05). Metastases of lymph nodes happened in 90.77% patients which positive expression of Tg, and 88% in patients which positive expression of Tg-Ab. There is no relation of expression of Tg and Tg-Ab with time and location of metastases of lymph nodes. But there is relation of expression of Tg and Tg-Ab with numbers of metastases of lymph nodes.Conclusions Both Tg and Tg-Ab can be indicator of metastases of lymph nodes of post-operated PTC patients inhibited by thyroid hormone, testing Tg and Tg-Ab at the same time can improve positive rate of metastases. Positive rate of Tg and Tg-Ab expression has relation of numbers of metastases of lymph nodes.