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目的:探讨并分析合并淋巴细胞性甲状腺炎(lymphocytic thyroiditis,LT)的甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理特征及生物学特征(BRAFV600E突变、RET蛋白表达)。方法:收集262例PTC患者,根据是否合并LT分为A(合并LT,n=77)、B(不合并LT,n=185)两组。分别统计两组年龄、性别、肿瘤大小、多灶性、包膜外侵、淋巴结转移和远处转移等临床病理特征。采用RT-PCR法检测PTC组织中BRAFV600E突变,免疫组化法检测RET在PTC组织中表达。结果:PTC合并LT比例为29.39%(77/262)。A组女性比例(84.42%)高于B组(61.08%),P<0.001。A组和B组肿瘤大小分别为(1.32±0.74)和(1.72±1.28)cm,P=0.002;甲状腺包膜外侵犯率分别为28.57%和72.97%,P<0.001;远处转移率分别为6.49%和16.76%,P=0.028;BRAFV600E突变阳性率分别为39.71%和78.52%,P<0.001。A组均显著低于B组,差异均有统计学意义,P<0.05。A组和B组RET蛋白表达阳性率分别为76.47%和53.33%,差异有统计学意义,P=0.001。A组和B组在多灶性、淋巴结转移及TNM分期方面则差异无统计学意义。在相同TSH水平下,A组和B组患者术前Tg水平分别为(11.52±26.46)和(48.92±167.12)ng/mL,P=0.261;Anti-Tg水平分别为(324.06±469.50)和(64.89±160.07)IU/mL,P=0.005;Anti-TPO水平分别为(219.36±273.03)和(23.33±43.62)IU/mL,P=0.001。术后131I治疗前Tg水平分别为(15.56±82.39)和(78.55±196.22)ng/mL,P=0.001。Anti-Tg水平分别为(226.44±315.62)和(94.07±389.71)IU/mL,P=0.019;Anti-TPO水平分别为(88.46±120.89)和(16.54±24.79)IU/mL,P=0.013。结论:RET蛋白表达与PTC合并LT的发生密切相关,BRAFV600E突变在PTC合并LT患者中较少见。淋巴细胞性甲状腺炎可作为一种保护机制降低PTC患者局部及远处侵袭性。
Objective: To investigate and analyze the clinicopathological features and biological characteristics of papillary thyroid carcinoma (PTC) with lymphocytic thyroiditis (LT). Methods: Two hundred and sixty-two patients with PTC were enrolled in the study. According to whether the combined LT was divided into A (with LT, n = 77) and B (without LT, n = 185) The clinical and pathological features of two groups including age, gender, tumor size, multifocality, extracapsular invasion, lymph node metastasis and distant metastasis were calculated. The BRAFV600E mutation was detected by RT-PCR and the expression of RET was detected by immunohistochemistry. Results: The PTC combined LT ratio was 29.39% (77/262). The proportion of women in group A (84.42%) was higher than that in group B (61.08%), P <0.001. The tumor size in group A and group B were (1.32 ± 0.74) and (1.72 ± 1.28) cm, respectively, P = 0.002. The extranodal invasion rate was 28.57% and 72.97% respectively, P <0.001. The distant metastasis rates were 6.49% and 16.76% respectively, P = 0.028. The positive rates of BRAFV600E mutation were 39.71% and 78.52%, respectively, P <0.001. A group were significantly lower than the B group, the difference was statistically significant, P <0.05. The positive rates of RET protein expression in group A and group B were 76.47% and 53.33%, respectively, with a significant difference (P = 0.001). There was no significant difference in multifocality, lymph node metastasis and TNM staging between group A and group B. At the same level of TSH, the preoperative Tg levels in group A and group B were (11.52 ± 26.46) and (48.92 ± 167.12) ng / mL, respectively, P = 0.261; the levels of anti-Tg were (324.06 ± 469.50) and 64.89 ± 160.07) IU / mL, P = 0.005; Anti-TPO levels were (219.36 ± 273.03) and (23.33 ± 43.62) IU / mL, respectively. Pretreatment 131I after treatment Tg levels were (15.56 ± 82.39) and (78.55 ± 196.22) ng / mL, P = 0.001. Anti-Tg levels were (226.44 ± 315.62) and (94.07 ± 389.71) IU / mL, respectively, P = 0.019; Anti-TPO levels were (88.46 ± 120.89) and (16.54 ± 24.79) IU / mL, respectively. CONCLUSIONS: The expression of RET protein is closely related to the occurrence of PTC with LT. The BRAFV600E mutation is rare in PTC patients with LT. Lymphocytic thyroiditis can serve as a protective mechanism to reduce the local and remote invasive PTC patients.