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目的：探讨促甲状腺激素(TSH)围手术期变化纵向轨迹与甲状腺良性结节(BTN)微波消融术后恢复之间的关系。方法：选取2021年10月至2024年10月我院收治的251例BTN患者作为研究对象，应用组基轨迹建模(GBTM)模型分组原则，确定TSH水平发展轨迹。采用多元线性回归分析不同TSH水平发展轨迹患者手术前后甲状腺功能与血清炎症因子的关系；采用Cox回归分析TSH水平变化轨迹与疗效的关系并进行趋势性检验；应用二元Log-binomial回归模型计算不同组患者术后并发症发生率的相对危险度(RR)。结果：在BTN患者中，识别到4种不同的TSH水平发展轨迹：低-稳定型(90例)、低-增长型(47例)、中-增长型(63例)、高-增长型(51例)。不同TSH水平发展轨迹的手术疗效差异存在统计学意义(P<0.05)，低-稳定型的显效率与总有效率最高，其次为低-增长型。不同TSH水平发展轨迹患者手术前后的甲状腺功能指标、血清炎症因子均存在统计学差异(P<0.05),FT3、FT4术后水平均低于术前，IL-8、hs-CRP、TNF-α术后水平均高于术前；术后4组患者甲状腺功能指标(FT3、FT4)与血清炎症因子(IL-8、hs-CRP、TNF-α)的差异均有统计学意义(P<0.05)。多元线性回归结果显示，TSH水平与甲状腺功能指标(FT3、FT4)呈负相关(P<0.05)，与血清炎症因子(IL-8、hs-CRP、TNF-α)呈正相关(P<0.05)。COX回归分析结果显示，以低-稳定型为参照，低-增长型、中-增长型、高-增长型趋势性检验差异具有统计学意义(P<0.001)。4组患者术后并发症总发生率差异具有统计学意义(P<0.05)，与低-稳定型比较，低-增长型、中-增长型、高-增长型患者术后并发症总发生率的风险升高(RR>1,P<0.05)。结论：TSH水平与甲状腺良性结节MWA后恢复密切相关，TSH水平与FT3、FT4呈负相关，与IL-8、hs-CRP、TNF-α呈正相关，低-稳定型的显效率与总有效率最高，其次为低-增长型。
Abstract：Objective: To investigate the relationship between the longitudinal trajectory of perioperative changes in TSH and recovery after microwave ablation of benign thyroid nodules. Methods: 251 BTN patients admitted to our hospital from October 2021 to October 2024 were selected as the study subjects, and the group-based trajectory modeling(GBTM) model grouping principle was applied to determine the development trajectory of TSH levels. Multiple linear regression was used to analyze the relationship between thyroid function and serum inflammatory factors before and after surgery in patients with different TSH level development trajectories; Cox regression was used to analyze the relationship between TSH level change trajectories and therapeutic efficacy and trend test was performed; binary logbinomial regression model was applied to calculate the relative risk(RR) of postoperative complication rates in different groups of patients. Results: In patients with BTN, four different trajectories of TSH level development were identified:low-stable(90 cases), low-growth(47 cases), medium-growth(63 cases), and high-growth(51 cases). There was a statistically significant difference in surgical efficacy between the developmental trajectories of different TSH levels(P<0.05), and the low-stable type had the highest apparent and overall efficacy rates, followed by the low-growth type.The postoperative and preoperative thyroid function indexes and serum inflammatory factors of patients with different TSH level development trajectories showed statistical differences(P<0.05), the postoperative index levels of FT3and FT4were lower than preoperative, and the postoperative index levels of IL-8, hs-CRP, and TNF-α were higher than the preoperative ones, and the postoperative indexes of thyroid function(FT3, FT4) and serum inflammatory factors of the four groups of patients(IL-8, hs-CRP, TNF-α) showed statistically significant differences(P<0.05). The results of multiple linear regression showed that TSH levels were negatively correlated(P<0.05) with thyroid function indices(FT3,FT4) and positively correlated(P<0.05) with serum inflammatory factors(IL-8, hs-CRP, TNF-α). The results of COX regression analysis showed that the difference in trend test was statistically significant(P<0.001) among low-growth,medium-growth, and high-growth types, using low-stable type as a reference. The difference in the total postoperative complication rate among the four groups was statistically significant(P<0.05), and the risk of total postoperative complications was elevated in patients with low-growth, medium-growth, and high-growth types compared with low-stable types(RR>1, P<0.05). Conclusion: TSH levels were closely associated with recovery after microwave ablation of benign thyroid nodules, TSH levels were negatively correlated with FT3and FT4, and positively correlated with IL-8, hs-CRP, and TNF-α. The low-stabilized type had the highest apparent and total efficiency, followed by the low-growth type.
[1] ALEXANDER EK, CIBAS ES. Diagnosis of thyroid nodules[J].Lancet Diabetes Endocrinol, 2022, 10(7):533-539. DOI:10.1016/S2213-8587(22)00101-2.
[2] KOBALY K, KIM CS, MANDEL SJ. Contemporary management of thyroid nodules[J].Annu Rev Med, 2022, 73(1):517-528. DOI:10.1146/annurev-med-042220-015032.
[3]彭玲，程静静.超声引导下射频消融术治疗甲状腺良性结节患者的短中期随访研究[J].山西医药杂志，2020,49(10):1240-1242.DOI:10.3969/j.issn.0253-9926.2020.10.019.
[4] ALEXANDER EK, DOHERTY GM, BARLETTA JA. Management of thyroid nodules[J].Lancet Diabetes Endocrinol, 2022, 10(7):540-548.
[5] JIANG WJ, YAN PJ, ZHAO CL,et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer:a systematic review and meta-analysis[J].Surg Endosc, 2020, 34(5):1891-1903. DOI:10.1007/s00464-019-07283-y.
[6]乐飞，欧阳骞，李红米.超声引导下微波消融术治疗甲状腺良性结节疗效的影响因素分析[J].实用癌症杂志，2019,34(9):1550-1552. DOI:10.3969/j.issn.1001-5930.2019.09.046.
[7] XU W, LI S, CHENG F, et al. Microwave ablation versus radiofrequency ablation for patients with primary and secondary hyperparathyroidism:a meta-analysis[J].Int Urol Nephrol, 2023, 55(9):2237-2247. DOI:10.1007/s11255-023-03543-y.
[8] ZHOU W, YU M, MAO X, et al. Landscape of the peripheral immune response induced by local microwave ablation in patients with breast cancer[J].Adv Sci(Weinh), 2022, 9(17):e2200033. DOI:10.1002/advs.202200033.
[9] TANG Y, SUN X, TIAN J, et al. Clinical efficacy analysis of ultrasound-guided microwave ablation for nodular goiters[J].Am J Transl Res, 2024, 16(9):4526-4533. DOI:10.62347/ACRT3772.
[10] HAN X, ZHANG Y, Li Y, et al. Ultrasound-Guided microwave ablation of thyroid schwannoma[J].JCEM Case Rep, 2024, 2(8):luae146. DOI:10.1210/jcemcr/luae146.
[11] ERTURK MS, CEKIC B, CELIK M, et al. Microwave ablation of symptomatic benign thyroid nodules:Short-and long-term effects on thyroid function tests, thyroglobulin and thyroid autoantibodies[J].Clin Endocrinol(Oxf), 2021, 94(4):677-683. DOI:10.1111/cen.14348.
[12] CHEN Z, GUO X, YIN X, et al. Ultrasound-guided microwave ablation of benign thyroid nodules:effects on inflammatory factors and thyroid function[J].Am J Transl Res, 2021, 3(12):13723-13731.
[13]孙爱军，戴慧娟，茅玲，等.超声引导下经皮微波消融技术对甲状腺良性结节的临床价值[J].中国现代普通外科进展，2017,20(10):799-801. DOI:10.3969/j.issn.1009-9905.2017.10.018.
[14]朱荣峰，钱章君，马铁梁，等.超声造影在甲状腺良性结节微波消融中的应用[J].中国现代普通外科进展，2023,26(11):886-888,902. DOI:10.3969/j.issn.1009-9905.2023.11.011.
[15]邓佳琳，王小平.超声引导下微波消融治疗甲状腺良性结节的临床效果及安全性评估[J].现代肿瘤医学，2022,30(21):3882-3886. DOI:10.3969/j.issn.1672-4992.2022.21.008.
[16] XU D, GE M, YANG A, et al. Expert consensus workshop report:Guidelines for thermal ablation of thyroid tumors(2019 edition)[J].J Cancer Res Ther, 2020, 16(5):960-966. DOI:10.4103/jcrt. JCRT_558_19.
[17] BRIET C, SUTEAU V, ILLOUZ F, et al. Thyrotropin-secreting tumor"TSH-PitNET":From diagnosis to treatment[J].Ann Endocrinol(Paris), 2023, 84(4):407-412. DOI:10.1016/j.ando.2023.01.004.
[18] BABIC LEKO M, GUNJACA I, PLEIC N, et al. Environmental factors affecting Thyroid-Stimulating hormone and thyroid hormone levels[J].Int J Mol Sci, 2021, 22(12):6521. DOI:10.3390/ijms22126521.
[19] XIA B, YU B, WANG X, et al. Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules[J].BMC Surg, 2021, 21(1):317.DOI:10.1186/s12893-021-01312-1.
[20] LANG X, LI Y, ZHANG D, ZHANG Y, et al. FT3/FT4 ratio is correlated with all-cause mortality, cardiovascular mortality, and cardiovascular disease risk:NHANES 2007-2012[J].Front Endocrinol(Lausanne). 2022, 13(1):964822. DOI:10.3389/fendo.2022.964822.
[21] DESTEK S, BENTURK B, YAPALAK Y, et al. Clinical significance of erythrocyte sedimentation rate, leukocyte, fibrinogen, C-reactive protein, and pPentraxin 3 values in thyroid nodules[J].Sisli Etfal Hastan Tip Bul, 2022, 56(2):270-275. DOI:10.14744/SEMB.2021.78871.
[22] CHEN Z, GUO X, YIN X, et al. Ultrasound-guided microwave ablation of benign thyroid nodules:effects on inflammatory factors and thyroid function[J].Am J Transl Res, 2021, 13(12):13723-13731.
[23] DOU JP, YU J, CHENG ZG, et al. Symptomatic aseptic necrosis of benign thyroid lesions after microwave ablation:risk factors and clinical significance[J].Int J Hyperthermia, 2021, 38(1):815-822.DOI:10.1080/02656736.2021.1930203.
[24] ERTURK MS, CEKIC B, CELIK M, et al. Microwave ablation of symptomatic benign thyroid nodules:Short-and long-term effects on thyroid function tests, thyroglobulin and thyroid autoantibodies[J].Clin Endocrinol(Oxf), 2021, 94(4):677-683. DOI:10.1111/cen.14348.
[25] DEMETRIOU E, FOKOU M, FRANGOS S, et al. Thyroid nodules and obesity[J].Life(Basel), 2023, 13(6):1292. DOI:10.3390/life13061292.
[26] MRABET HE, MABROUK AB, BOUBAKER F,et al.Impact of nonsevere infections on cortisol and thyroid stimulating hormone baseline levels in hospitalized patients:A monocentric cross-sectional study[J].Endocrine Regulations, 2024, 58(1):158-167. DOI:10.2478/enr-2024-0018.
[27] MIRO C, GIOVANNI AD, MUROLO M,et al.Thyroid hormone and androgen signals mutually interplay and enhance inflammation and tumorigenic activation of tumor microenvironment in prostate cancer[J].Cancer Letters, 2022, 532(1):215581. DOI:10.1016/j. canlet.2022.215581.
基本信息:
DOI：
中图分类号:R653
引用信息:
[1]罗宝钰,姜隽.促甲状腺激素围手术期变化纵向轨迹与甲状腺良性结节微波消融术后恢复的关系[J].中国现代普通外科进展,2025,28(06):421-428.
基金信息:
国家自然科学基金项目(82070288)