术前血小板参数与分化型甲状腺癌临床病理特征的相关性

王学昌; 刘文静; 赵明俊

doi:10.13201/j.issn.2096-7993.2023.10.006

术前血小板参数与分化型甲状腺癌临床病理特征的相关性

- 东南大学附属中大医院耳鼻咽喉头颈外科(南京，210009)

详细信息

通讯作者: 赵明俊，E-mail：zhaomj4206@163.com

中图分类号: R736.1

收稿日期: 2023-04-25

刊出日期: 2023-10-03

Correlation between preoperative platelet parameters and clinicopathological features of differentiated thyroid cancer

- Department of Otorhinolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing, 210009, China

More Information

Corresponding author: ZHAO Mingjun, E-mail: zhaomj4206@163.com

Received Date: 25 April 2023

Publish Date: 03 October 2023

摘要

摘要: 目的探讨术前血小板参数与分化型甲状腺癌的临床病理特征相关性。方法回顾性分析东南大学附属中大医院2019年1月-2020年12月收治的甲状腺肿瘤患者及此期间在我院体检中心体检结果正常的健康成年人，收集他们的一般信息及术前血常规数据。排除非分化型甲状腺癌、糖尿病、冠心病、血液系统疾病、肾脏疾病、自身免疫性疾病、遗传性疾病、合并感染性疾病、全身其他肿瘤、肝炎或肝硬化、服用抗凝药物等可能影响血小板等疾病的患者；健康成年人的排除标准为：排除上述疾病且体检结果正常的健康成年人。比较各组血小板参数的差异，分析甲状癌的临床病理特征以及伴随颈部淋巴结转移与患者血小板参数的相关性。采用多因素logistics回归模型分析甲状腺癌合并颈部淋巴结转移的危险因素。结果共收集分化型甲状腺癌患者117例，男33例，女84例，平均年龄(41.64±12.25)岁；46例甲状腺良性肿瘤患者，其中男15例，女31例，平均年龄(41.35±12.52)岁；50例同期体检结果正常的健康成年人，其中男18例，女32例，平均年龄(42.02±9.62)岁，无合并基础疾病。分化型甲状腺癌组PLT高于甲状腺良性肿瘤组(t=-2.219，P=0.028)及正常对照组(t=2.069，P=0.04)，甲状腺癌组PDW低于良性肿瘤组(t=2.238，P=0.027)及对照组(t=-2.618，P=0.002)，差异有统计学意义。术前年龄≤45岁(χ²=4.225，P=0.04)、肿瘤直径>1 cm(χ²=4.415，P=0.036)、血小板计数(PLT)(t=-4.018，P < 0.01)升高、PDW(t=4.568，P < 0.01)降低与甲状腺癌伴颈部淋巴结转移显著相关，差异有统计学意义。单因素分析发现年龄≤45岁(OR=0.447，95%CI 0.206~0.970，P=0.042)、肿瘤直径>1 cm(OR=2.3，95%CI 1.050~5.039，P=0.037)，PLT(OR=1.012，95%CI 1.050~1.019，P=0.001)，PDW(OR=0.677，95%CI 0.564~0.813，P < 0.01)，是甲状腺颈部淋巴结转移的危险因素。多因素logistics回归分析结果显示PLT(OR=1.008，95%CI 1.001~1.016，P=0.026)，PDW(OR=0.692，95%CI 0.564~0.848，P < 0.01)，是甲状腺癌合并颈部淋巴结转移的独立危险因素。结论 PLT和PDW可能是鉴别甲状腺癌良恶性及中央区淋巴结转移有意义的预测因子。
- 甲状腺肿瘤 /
- 血小板 /
- 临床特征 /
- 病理特征 /
- 淋巴结转移
Abstract: Objective To investigate the correlation between preoperative platelet parameters and the clinicopathological features of differentiated thyroid cancer.Methods We retrospectively analyzed the medical records of patients with thyroid tumors admitted to Zhongda Hospital affiliated to Southeast University and healthy adults with normal physical examination results in our hospital from January 2019 to December 2020, and collected their general information and preoperative blood routine data. Patients with undifferentiated thyroid cancer, diabetes, coronary heart disease, hematological diseases, kidney diseases, autoimmune diseases, genetic diseases, infectious diseases, other systemic tumors, hepatitis or cirrhosis, or those taking anticoagulants were excluded. The exclusion criteria for healthy adults were the absence of the above diseases and normal physical examination results. Differences in platelet parameters among the three groups were compared, and the correlation between clinicopathological characteristics of thyroid cancer, accompanying cervical lymph node metastasis, and platelet parameters of patients was analyzed. A multivariate logistic regression model was used to analyze the risk factors of thyroid cancer with cervical lymph node metastasis.Results A total of 117 cases of differentiated thyroid cancer were collected, including 33 males and 84 females, with an average age of (41.64±12.25) years; 46 patients had benign thyroid tumors, including 15 males and 31 females, with an average age of (41.35±12.52) years; 50 healthy adults with normal physical examination results in our hospital during the same period were also included, including 18 males and 32 females, with an average age of(42.02±9.62) years, without underlying diseases. The platelet count of the differentiated thyroid cancer group was higher than that of the benign thyroid tumor group(t=-2.219, P=0.028) and the normal control group(t=2.069, P=0.04), while the platelet distribution width of the differentiated thyroid cancer group was lower than that of the benign thyroid tumor group(t=2.238, P=0.027) and the normal control group(t=-2.618, P=0.002). These differences were statistically significant. Preoperative age ≤45 years(χ²=4.225, P=0.04), tumor diameter>1 cm(χ²=4.415, P=0.036), PLT(t=-4.018, P < 0.01) increase, and PDW(t=4.568, P < 0.01) decrease were significantly correlated with cervical lymph node metastasis of thyroid cancer and had statistical significance. Univariate analysis showed that age ≤45 years(OR=0.447, 95%CI 0.206-0.970, P=0.042), tumor diameter>1 cm(OR=2.3, 95%CI 1.050-5.039, P=0.037), PLT(OR=1.012, 95%CI 1.005-1.019, P=0.001), and PDW(OR=0.693, 95%CI 0.518-0.827, P < 0.01) were risk factors for cervical lymph node metastasis of thyroid cancer. The results of multifactorial logistic regression analysis showed that PLT(OR=1.008, 95%CI 1.001-1.016, P=0.026) and PDW(OR=0.692, 95%CI 0.564-0.848, P < 0.01) were independent risk factors for thyroid cancer with cervical lymph node metastasis.Conclusion PLT and PDW may be useful predictive factors for the differentiation of thyroid cancer malignancy and central lymph node metastasis.
- thyroid cancer /
- platelet /
- clinical characteristics /
- pathological features /
- lymph node metastasis

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表 1 TC组与良性肿瘤组匹配后的临床资料和血小板参数比较 X±S

项目	TC组(n=117)	良性肿瘤组(n=46)	P
性别/例(%)			0.579
男	33(20.3)	15(9.2)
女	84(51.5)	31(19.0)
有无高血压/例(%)			0.799
有	25(15.3)	9(5.5)
无	92(56.4)	37(22.7)
年龄/岁	41.64±12.25	41.35±12.52	0.890
PLT/×10⁹/L	249.30±60.24	225.87±50.44	0.028
LY/10⁹/L	1.94±0.61	1.80±0.66	0.200
MPV/fl	10.20±1.98	10.61±1.18	0.190
PDW/fl	14.00±2.32	14.88±2.09	0.027
P-LCR/%	29.00±9.56	30.11±7.98	0.490
PLT/LY/%	137.13±46.74	139.09±53.32	0.820

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表 2 TC组与对照组的临床资料和血小板参数比较

项目	TC组(n=117)	对照组(n=50)	P
性别/例(%)			0.316
男	33(20.3)	18(9.2)
女	84(51.5)	32(19.0)
年龄/岁	41.64±12.25	42.02±9.62	0.850
PLT/×10⁹/L	249.30±60.24	228.26±49.38	0.040
LY/×10⁹/L	1.94±0.61	1.74±0.57	0.060
MPV/fl	10.20±1.98	10.60±1.09	0.190
PDW/fl	14.00±2.32	14.97±1.91	0.002
P-LCR/%	29.00±9.56	30.09±7.82	0.480
PLT/LY/%	137.13±46.74	142.18±51.50	0.540

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表 3 良性肿瘤组与对照组的临床资料和血小板参数比较

项目	对照组(n=50)	良性肿瘤组(n=46)	P
性别/例(%)			0.727
男	18(20.3)	15(9.2)
女	32(51.5)	31(19.0)
年龄/岁	42.02±9.62	41.35±12.52	0.760
PLT/×10⁹/L	228.26±49.38	225.87±50.44	0.810
LY/×10⁹/L	1.74±0.57	1.80±0.66	0.670
MPV/fl	10.60±1.09	10.61±1.18	0.940
PDW/fl	14.97±1.90	14.88±2.09	0.810
P-LCR/%	30.00±7.80	30.11±7.98	0.990
PLT/LY/%	142.18±51.50	139.09±53.32	0.770

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表 4 TC患者术前PLT与淋巴结转移结果的相关性例

项目/N分期	N0(n=64)	N1(n=53)	P
性别			0.397
男	16	17
女	48	36
年龄			0.040
≤45岁	34	38
>45岁	30	15
肿瘤直径			0.036
≤1 cm	48	30
>1 cm	16	23
PLT/×10⁹/L	228.74±65.99	272.62±50.91	< 0.010
LY/×10⁹/L	1.84±0.62	1.99±0.59	0.160
MPV/fl	10.04±2.35	10.49±1.19	0.210
PDW/fl	14.75±2.10	12.97±2.20	< 0.010
P-LCR/%	29.11±10.02	29.37±8.71	0.880
PLT/LY/%	132.85±46.40	145.95±46.30	0.123

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表 5 TC淋巴结转的多因素logistics回归分析

指标	单因素		多因素
指标	OR(95%CI)	P	OR(95%CI)	P
男性	0.706(0.315~1.584)	0.398
年龄≤45岁	0.447(0.206~0.970)	0.042	2.199(0.884~5.473)	0.090
肿瘤直径>1 cm	2.300(1.050~5.039)	0.037	2.068(0.838~5.103)	0.115
PLT	1.012(1.005~1.019)	0.001	1.008(1.001~1.016)	0.026
PDW	0.693(0.518~0.827)	< 0.010	0.692(0.564~0.848)	< 0.010

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