甲状腺乳头状癌患者血钙、甲状旁腺激素、NLR变化及与预后的关系

陈豪; 肖仁意; 倪晓锋; 周毅力

doi:10.16766/j.cnki.issn.1674-4152.004242

甲状腺乳头状癌患者血钙、甲状旁腺激素、NLR变化及与预后的关系

doi: 10.16766/j.cnki.issn.1674-4152.004242

温州医科大学附属第一医院甲状腺外科，浙江温州 325000

基金项目:

浙江省自然科学基金项目 LY20H160011

温州市科技局基金项目 Y2023494

详细信息

通讯作者:
周毅力，E-mail：yilistar@163.com

中图分类号: R736.1 A730.7
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出版历程
- 收稿日期: 2024-09-30
- 网络出版日期: 2026-01-07

Variation of serum calcium, parathyroid hormone and NLR, and their relationship between prognosis of patients with papillary thyroid carcinoma

Department of Thyroid Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的甲状腺乳头状癌(PTC)术后部分患者预后较差，探讨血钙、甲状旁腺激素(PTH)、炎症指标对患者复发和转移的影响。方法选取2019年1月—2021年1月温州医科大学附属第一医院收治的87例PTC患者，患者均接受甲状腺切除术治疗。术后进行为期3年的随访，统计患者复发/转移情况，并根据复发/转移情况分为预后良好组(37例)和预后不良组(50例)。比较患者手术前后外周血血钙、甲状旁腺激素、中性粒细胞与淋巴细胞比率(NLR)水平。比较预后良好组和预后不良组患者临床资料及术后外周血血钙、甲状旁腺激素、NLR水平。采用ROC曲线分析血钙、甲状旁腺激素、NLR水平对PTC患者预后评估的价值。结果 PTC患者手术后外周血血钙、PTH、NLR水平均明显低于手术前(P＜0.05)。随访3年，共有37例PTC患者发生复发/转移，发生率为42.53%。预后不良组外周血血钙低于预后良好组，甲状旁腺激素、NLR水平高于预后良好组(P＜0.05)。2组患者手术至¹³¹Ⅰ治疗时间、术前淋巴结转移、肿瘤分期比较差异均有统计学意义(P＜0.05)。ROC曲线分析显示，术后外周血血钙、甲状旁腺激素、NLR水平及联合检测评估PTC患者预后的AUC分别为0.724、0.690、0.734、0.929(P＜0.05)。结论 PTC患者术后外周血血钙、PTH、NLR水平明显低于手术前，三者联合检测对PTC患者预后评估具有临床价值。
- 甲状腺乳头状癌 /
- 血钙 /
- 甲状旁腺激素 /
- 中性粒细胞与淋巴细胞比值 /
- 预后
Abstract: Objective Postoperative prognoses of papillary thyroid carcinoma (PTC) exhibit significant inter-patient variability, with some patients experiencing unfavourable outcomes. This study aims to investigate the impact of serum calcium, parathyroid hormone, and inflammatory markers on recurrence and metastasis in PTC patients. Methods A total of 87 patients with PTC undergoing surgical resection at the First Affiliated Hospital of Wenzhou Medical University were enrolled between January 2019 and January 2021. Patients were subjected to a three-year follow-up period after surgery in order to statistically analyze the recurrence and metastasis of the disease. The present study set out to compare the levels of peripheral blood calcium, PTH and NLR were compared before and after surgery. A comparison was made of the clinical data, levels of peripheral blood calcium, PTH and NLR in the good prognosis group and poor. The prognostic value of serum calcium, PTH and NLR was analyzed by receiver operating characteristic (ROC) curve analysis. Results Post-surgically, there was a significant decrease in the levels of peripheral blood calcium, PTH and NLR in patients with PTC (P < 0.05). After 3 years of follow-up, there were 37 cases (42.53%) exhibited signs of recurrence or metastasis. The level of peripheral blood calcium in the poor prognosis group was lower than that in the good prognosis group, PTH and NLR in the poor prognosis group were higher than those in the good prognosis group (P < 0.05). The two groups differed significantly two groups in terms of time from operation to ¹³¹Ⅰ treatment, preoperative lymph node metastasis, and tumor stage (P < 0.05). ROC curve analysis demonstrated that the area under the curve (AUC) value of calcium, PTH, NLR and combined detection for evaluating the prognosis of PTC patients was 0.724, 0.690, 0.734 and 0.929 (all P < 0.05). Conclusion Post-surgically, there is a marked decrease in the levels of peripheral blood calcium, PTH and NLR are significantly decreased in PTC patients. The combined detection of the three indexes has evaluation value for the prognosis of PTC patients.
- Papillary thyroid carcinoma /
- Serum calcium /
- Parathyroid hormone /
- Neutrophil-to-lymphocyte ratio /
- Prognosis

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图 1 术后血钙、甲状旁腺激素、NLR水平预测PTC患者预后的ROC曲线

Figure 1. ROC curves of postoperative serum calcium, parathyroid hormone, and NLR levels for predicting outcomes in patients with PTC

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表 1 87例PTC患者手术前后外周血血钙、甲状旁腺激素、NLR水平比较

Table 1. Comparison of serum calcium, parathyroid hormone, and NLR levels in peripheral blood of patients with PTC before and after surgery

时间	血钙(x±s，mmol/L)	PTH [M(P₂₅, P₇₅)，pg/mL]	NLR [M(P₂₅, P₇₅)]
手术前	2.36±0.21	27.08(22.60，57.70)	2.47(1.70，3.30)
手术后	2.04±0.19	16.40(9.84，22.80)	1.44(1.05，2.12)
统计量	10.568^a	-5.639^b	-6.035^b
P值	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为Z值。

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表 2 预后不良组和预后良好组PTC患者临床资料比较

Table 2. Comparison of clinical data between PTC patients with poor and favorable prognoses

项目	预后不良组(n=37)	预后良好组(n=50)	统计量	P值
性别[例(%)]
男性	21(56.76)	29(58.00)	0.013^a	0.908
女性	16(43.24)	21(42.00)
年龄(x±s，岁)	51.41±12.85	47.92±10.63	1.383^b	0.170
手术方式[例(%)]			0.033^a	0.857
全切	17(45.95)	22(44.00)
腺叶切除或次全切	20(54.05)	28(56.00)
家族遗传史[例(%)]			0.258^a	0.612
有	15(40.54)	23(46.00)
无	22(59.46)	27(54.00)
吸烟史[例(%)]			0.506^a	0.477
是	24(64.86)	36(72.00)
否	13(35.14)	14(28.00)
职业暴露史[例(%)]			0.607^a	0.436
是	2(5.41)	5(10.00)
否	35(94.59)	45(90.00)
合并桥本氏甲状腺炎[例(%)]			0.177^a	0.674
是	8(21.62)	9(18.00)
否	29(78.38)	41(82.00)
合并毒性弥漫性甲状腺肿[例(%)]			0.127^a	0.722
是	7(18.92)	8(16.00)
否	30(81.08)	42(84.00)
手术至¹³¹Ⅰ治疗时间[例(%)]			12.879^a	＜0.001
>3个月	23(62.16)	12(24.00)
≤3个月	14(37.84)	38(76.00)
术前淋巴结转移[例(%)]			4.476^a	0.034
有	21(56.76)	17(34.00)
无	16(43.24)	33(66.00)
肿瘤分期[例(%)]			11.191^a	0.001
Ⅰ~Ⅱ期	11(29.73)	33(66.00)
Ⅲ~Ⅳ期	26(70.27)	17(34.00)
注：^a为χ²值，^b为t值。

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表 3 预后不良组和预后良好组PTC患者术后外周血血钙、PTH、NLR水平比较(x±s)

Table 3. Comparison of postoperative peripheral blood levels of calcium, PTH, and NLR between PTC patients with poor prognosis and favorable prognoses (x±s)

组别	例数	血钙(mmol/L)	PTH(pg/mL)	NLR
预后不良组	37	1.96±0.24	26.98±3.24	2.16±0.27
预后良好组	50	2.10±0.10	15.07±1.69	1.36±0.24
t值		3.793	22.251	14.573
P值		＜0.001	＜0.001	＜0.001

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表 4 术后血钙、甲状旁腺激素、NLR水平预测PTC患者预后价值

Table 4. The prognostic value of postoperative serum calcium, parathyroid hormone, and NLR levels in patients with PTC

指标	AUC	95% CI	灵敏度(%)	特异度(%)	截断值	P值
血钙	0.724	0.612~0.835	96.00	48.60	1.95 mmol/L	＜0.001
PTH	0.690	0.567~0.812	51.40	92.00	20.53 pg/mL	0.003
NLR	0.734	0.624~0.843	64.90	78.00	1.62	＜0.001
联合检测	0.929	0.872~0.986	91.90	88.00		＜0.001

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参考文献(21)

[1]	PELIZZO M R, MAZZA E I, MIAN C, et al. Medullary thyroid carcinoma[J]. Expert Rev Anticancer Ther, 2023, 23(9): 943-957. doi: 10.1080/14737140.2023.2247566
[2]	PEREIRA-MACEDO J, FREIRE B, MACEDO-OLIVEIRA C, et al. Hyperfunctioning papillary thyroid carcinoma: a case report and literature review[J]. Acta Chir Belg, 2024, 124(2): 147-152. doi: 10.1080/00015458.2023.2210699
[3]	PAK S J, KWON D, KIM B C, et al. Contralateral low-to-intermediate suspicion nodule is not a contraindication for lobectomy in patients with papillary thyroid carcinoma[J]. Thyroid, 2023, 33(11): 1339-1348. doi: 10.1089/thy.2023.0270
[4]	陈波, 黄际远, 张伟, 等. 核医学检查在评估中低危分化型甲状腺癌患者术后淋巴结转移中的价值[J]. 西部医学, 2024, 36(4): 604-607. CHEN B, HUANG J Y, ZHANG W, et al. The value of partial nuclear medical examination on lymph node metastasis in patients with moderate and low-risk differentiated thyroid cancer after operation[J]. Medical Journal of West China, 2024, 36(4): 604-607.
[5]	ZHANG L, LIU N, SHAO J, et al. Bidirectional control of parathyroid hormone and bone mass by subfornical organ[J]. Neuron, 2023, 111(12): 1914-1932. doi: 10.1016/j.neuron.2023.03.030
[6]	XIANG Y M, ZHANG N N, LEI H K, et al. Neutrophil-to-lymphocyte ratio is a negative prognostic biomarker for luminal A breast cancer[J]. Gland Surgm, 2023, 12(3): 415-425. doi: 10.21037/gs-23-80
[7]	孙家和, 刘元, 李志祥, 等. 术前中性粒细胞/淋巴细胞比值对cN0期甲状腺微小乳头状癌中央区淋巴结转移的预测价值[J]. 中华全科医学, 2020, 18(12): 2006-2009. SUN J H, LIU Y, LI Z X, et al. The predictive value of preoperative neutrophil-to-lymphocyte ratio for central node lymph node metastasis in cN0 patients with papillary thyroid microcarcinoma[J]. Chinese Journal of General Practice, 2020, 18(12): 2006-2009.
[8]	JO K, KIM M H, HA J, et al. Prognostic value of preoperative anti- thyroglobulin antibody in differentiated thyroid cancer[J]. Clin Endocrinol, 2017, 87(3): 292-299. doi: 10.1111/cen.13367
[9]	IJAZ K, YIN F. Papillary thyroid carcinoma with squamous dedifferentiation: a potential diagnostic pitfall[J]. Anticancer Res, 2023, 43(1): 255-258. doi: 10.21873/anticanres.16157
[10]	ZHANG D, ZHU X L, JIANG J. Papillary thyroid carcinoma with breast and bone metastasis[J]. Ear Nose Throat J, 2023, 102(4): 259-262. doi: 10.1177/01455613221145273
[11]	XIE R, CHEN W Z, LV Y X, et al. Overexpressed ZC3H13 suppresses papillary thyroid carcinoma growth through m6A modification-mediated IQGAP1 degradation[J]. J Formos Med Assoc, 2023, 122(8): 738-746. doi: 10.1016/j.jfma.2022.12.019
[12]	ZHANG L, LIU N, SHAO J, et al. Bidirectional control of parathyroid hormone and bone mass by subfornical organ[J]. Neuron, 2023, 111(12): 1914-1932. doi: 10.1016/j.neuron.2023.03.030
[13]	KATO K, NAKASHIMA A, MORISHITA M, et al. Parathyroid hormone levels and pulse wave velocity in hemodialysis patients[J]. Ther Apher Dial, 2023, 27(3): 552-561. doi: 10.1111/1744-9987.13957
[14]	朱江, 那将超, 田国标, 等. 纳米炭在甲状腺乳头状癌淋巴结清扫中的价值及对术后甲状旁腺激素的影响[J]. 中国耳鼻咽喉头颈外科, 2022, 29(3): 141-145. ZHU J, NA J C, TIAN G B, et al. The value of nanocarbon in lymph node dissection of papillary thyroid carcinoma and its effect on the level of postoperative parathyroid hormone[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2022, 29(3): 141-145.
[15]	SERBAN D, PAPANAS N, DASCALU A M, et al. Significance of neutrophil to lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in diabetic foot ulcer and potential new therapeutic targets[J]. Int J Low Extrem Wounds, 2024, 23(2): 205-216. doi: 10.1177/15347346211057742
[16]	LIU X S, LI J Q, SUN L L, et al. The association between neutrophil-to-lymphocyte ratio and disease activity in rheumatoid arthritis[J]. Inflammopharmacology, 2023, 31(5): 2237-2244. doi: 10.1007/s10787-023-01273-2
[17]	AHMED M, EL AMROUSY D, HODEIB H, et al. Neutrophil-to-lymphocyte ratio as a predictive and prognostic marker in children with dilated cardiomyopathy[J]. Cardiol Young, 2023, 33(12): 2493-2497. doi: 10.1017/S1047951123000501
[18]	郭斌, 陈蕊, 王圣应, 等. 208例甲状腺乳头状癌患者颈部淋巴结转移相关因素分析[J]. 中华全科医学, 2022, 20(2): 195-198, 262. doi: 10.16766/j.cnki.issn.1674-4152.002310 GUO B, CHEN R, WANG S Y, et al. Analysis of factors related to cervical lymph node metastasis in 208 patients with papillary thyroid carcinoma[J]. Chinese Journal of General Practice, 2022, 20(2): 195-198, 262. doi: 10.16766/j.cnki.issn.1674-4152.002310
[19]	王声, 夏书官, 任阳光. C反应蛋白与清蛋白比值变化与甲状腺乳头状癌患者切除术后复发转移的关系[J]. 实用癌症杂志, 2023, 38(6): 941-945. WANG S, XIA S G, REN Y G. Relationship between the change of C-reactive protein/albumin ratio and the recurrence and metastasis of papillary thyroid carcinoma after resection[J]. The Practical Journal of Cance, 2023, 38(6): 941-945.
[20]	蔡晓雨, 谭建, 孟召伟, 等. ¹³¹Ⅰ治疗后复发或转移的分化型甲状腺癌患者临床特征分析[J]. 中华内分泌代谢杂志, 2020, 36(8): 684-689. CAI X Y, TAN J, MENG Z W, et al. Clinical features of patients with recurrent or metastatic differentiated thyroid carcinoma after 131Ⅰ therapy[J]. Chinese Journal of Endocrinology and Metabolis, 2020, 36(8): 684-689.
[21]	金凤钟, 宁晓暄, 邓玉洁, 等. 中性粒细胞与淋巴细胞比值在合并桥本甲状腺炎的老年微小甲状腺乳头状癌患者中的诊断价值[J]. 中华老年多器官疾病杂志, 2023, 22(10): 729-732. JIN F Z, NING X X, DENG Y J, et al. Diagnostic value of neutrophil-to-lymphocyte ratio for papillary thyroid micro-carcinoma in elderly patients with Hashimoto's thyroiditis[J]. Chinese Journal of Multiple Organ Diseases in the Elderly, 2023, 22(10): 729-732.