NLR、TgAb与甲状腺乳头状癌颈部淋巴结转移的关系

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摘要目的探究中性粒细胞/淋巴细胞比值（NLR）、甲状腺球蛋白抗体（TgAb）与甲状腺乳头状癌颈部淋巴结转移的关系。方法对2017年1月～2019年9月淮南市第一人民医院诊治的135例甲状腺乳头状癌患者进行临床研究，根据患者是否发生颈部淋巴结转移将其分为未转移组（72例）和转移组（63例）。记录两组患者的临床资料和病史资料，采用血细胞自动分析仪检测NLR值，采用全自动生化分析仪检测患者的生化指标，采用酶联免疫吸附法检测血清TgAb水平。采用logistic回归模型分析发生颈部淋巴结转移的影响因素，采用受试者工作特征曲线（ROC）分析NLR和血清TgAb对发生颈部淋巴结转移的预测价值。结果转移组的肿瘤直径、尿酸、尿素氮、肌酐、总胆红素、NLR和血清TgAb高于未转移组，差异有统计学意义（P ＜ 0.05）。两组患者性别、年龄、高血压史、冠心病史、糖尿病史、合并甲状腺肿、肿瘤数量、胆固醇、三酰甘油、高密度脂蛋白和低密度脂蛋白比较，差异无统计学差异（P ＞ 0.05）。logistic回归模型显示NLR和血清TgAb水平升高是甲状腺乳头状癌患者颈部淋巴结转移的独立危险因素（P ＜ 0.05）。NLR联合血清TgAb[AUC = 0.874,95%CI（0.816～0.932），灵敏度=89.76%，特异度=90.58%]预测颈部淋巴结转移的临床价值明显优于NLR[AUC = 0.753，95%CI（0.673～0.833），灵敏度=76.53%，特异度=79.12%]和血清TgAb[AUC = 0.796，95%CI（0.724～0.869），灵敏度=80.47%，特异度=83.91%]单独检测。结论 NLR和血清TgAb水平异常升高均与甲状腺乳头状癌患者颈部淋巴结转移的发生密切相关，早期联合检测有助于预测甲状腺乳头状癌患者颈部淋巴结转移的发生风险，从而为临床制订针对性干预方案提供参考。

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	许克杨枋谢应海王培斌

关键词 ：中性粒细胞/淋巴细胞比值, 甲状腺球蛋白抗体, 甲状腺乳头状癌, 颈部淋巴结转移

Abstract：Objective To explore the relationship between neutrophil to lymphocyte ratio (NLR), thyroglobulin antibody (TgAb) and cervical lymph node metastasis of papillary thyroid carcinoma. Methods A clinical study was conducted on 135 patients with papillary thyroid carcinoma diagnosed and treated in Huainan First People′s Hospital from January 2017 to September 2019. The patients were divided into the non-metastatic group (72 cases) and the metastatic group (63 cases) according to whether they had cervical lymph node metastasis. Clinical data and medical history of patients in the two groups were recorded. NLR value was measured by automatic blood cell analyzer, biochemical indicators of the patients were measured by automatic biochemical analyzer, and serum TgAb level was measured by enzyme-linked immunosorbent assay. Logistic regression model was used to analyze the influencing factors of cervical lymph node metastasis, and receiver operating characteristic (ROC) curve was used to predict the value of NLR and serum TgAb for cervical lymph node metastasis. Results Tumor diameter, uric acid, urea nitrogen, creatinine, total bilirubin, NLR and serum TgAb were significantly higher in the metastatic group than in the non-metastatic group (P ＜ 0.05). There was no statistically significant difference between the two groups in gender, age, history of hypertension, history of coronary heart disease, history of diabetes, combined goiter, number of tumors, cholesterol, triglyceride, high density lipoprotein and low density lipoprotein (P ＞ 0.05). Logistic regression model showed that elevated NLR and serum TgAb levels were independent risk factors for cervical lymph node metastasis in patients with papillary thyroid carcinoma (P ＜ 0.05). The clinical value of NLR combined with serum TgAb [AUC = 0.874, 95%CI (0.816 - 0.932), sensitivity = 89.76%, specificity = 90.58%] in predicting cervical lymph node metastasis was significantly better than that of NLR [AUC = 0.753, 95%CI (0.673 - 0.833), sensitivity = 76.53%, specificity = 79.12%] and serum TgAb [AUC = 0.796, 95%CI (0.724 - 0.869), sensitivity = 80.47%, specificity = 83.91%] alone. Conclusion Abnormally elevated levels of NLR and serum TgAb levels are closely related to the occurrence of cervical lymph node metastasis in patients with papillary thyroid carcinoma. Early combined detection is helpful to predict the risk of cervical lymph node metastasis in patients with papillary thyroid carcinoma, so as to provide reference for clinical development of targeted intervention programs.

Key words： Neutrophil to lymphocyte ratio Thyroglobulin antibody Papillary thyroid carcinoma Cervical lymph node metastasis

基金资助:安徽省自然科学基金项目（1708085MH0111）。

通讯作者: 王培斌（1972.12-），男，主任医师；研究方向：普通外科。

作者简介: 许克（1982.10-），男，硕士；研究方向：甲状腺外科、血管外科。

引用本文:

许克杨枋谢应海王培斌. NLR、TgAb与甲状腺乳头状癌颈部淋巴结转移的关系[J]. 中国医药导报, 2020, 17(11): 93-97.
XU Ke YANG Fang XIE Yinghai WANG Peibin. Relationship between NLR, TgAb and cervical lymph node metastasis in papillary thyroid carcinoma. 中国医药导报, 2020, 17(11): 93-97.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I11/93

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