Cancers (Basel):筛查导致高估甲状腺功能障碍和甲状腺炎与甲状腺癌风险的关系

2021-12-20 从医路漫漫 MedSci原创

甲状腺功能障碍和甲状腺癌之间的联系是有争议的。虽然一些研究报告甲状腺功能减退会增加甲状腺癌的风险,但另一些研究报告了相互矛盾的结果。一些研究显示甲状腺机能亢进患者继发甲状腺癌的风险增加。

背景及目的:甲状腺功能障碍和甲状腺癌之间的联系是有争议的。虽然一些研究报告甲状腺功能减退会增加甲状腺癌的风险,但另一些研究报告了相互矛盾的结果。一些研究显示甲状腺机能亢进患者继发甲状腺癌的风险增加。甲状腺炎,包括自身免疫性甲状腺炎,如桥本氏甲状腺炎和 Graves病,是碘充足地区甲状腺功能障碍的最常见原因,也与甲状腺癌风险有关,但结论的一致性较低。甲状腺功能障碍和甲状腺炎可能与甲状腺癌的发生有关。甲状腺激素和促甲状腺激素(TSH)可促进甲状腺癌细胞增殖和血管生成,并调节多个基因的表达。此外,甲状腺功能障碍可能通过混杂因素产生间接影响,如肥胖、血清胆固醇水平和吸烟,这些都是已知的与甲状腺癌有关的因素。甲状腺炎的炎症状态可能导致DNA损伤,导致甲状腺癌的突变。此外,桥本甲状腺炎可能与甲状腺癌有共同的发病机制,如激活致癌途径或刺激过量碘摄入。Graves病可以通过TSH受体刺激抗体的模拟TSH效应促进甲状腺癌的生长。此外,可能通过筛查导致该人群中甲状腺癌的检出率高于没有甲状腺疾病的人群,因为患有良性甲状腺疾病的患者可能会接受更多的甲状腺超声检查。我们的目的是评估甲状腺功能障碍和甲状腺炎与随后的甲状腺癌的关系(由于各种混杂因素,这是有争议的),以及甲状腺疾病检查对这种关系的影响。

方法:本研究分为研究I和研究II,前者使用韩国国民健康保险服务(NHIS)-健康筛查队列数据,包括所有健康筛查参与者的10%随机样,后者使用NHIS数据覆盖整个韩国人口。

在Study I中,我们分析了2002 - 2015年的队列数据。甲状腺癌患者从514,866名参与者中选择615,488,428个医疗索赔代码(n= 5769)。对照组从所有非甲状腺癌患者中选取(n= 509,097)。为了只包括新诊断为甲状腺癌的患者,我们排除了2002年诊断为甲状腺癌的患者(n= 102)。在甲状腺癌患者,病人没有总胆固醇数据排除在外(n = 1)。在控制参与者,我们排除了那些死在2003或失踪记录2003年之后(n = 34)和那些有一个国际疾病分类修订10 (icd - 10)代码C73没有甲状腺切除术(n = 2054)。甲状腺癌患者在年龄、性别、收入和居住地区方面与对照组进行1:4匹配。为减少选择偏差,采用随机数法随机选取对照组。每个甲状腺癌患者的指标日期定义为诊断甲状腺癌的时间。每个对照参与者的索引日期被确定为他们匹配的甲状腺癌患者的索引日期。在匹配过程中,484,345名对照组参与者被排除在外。最后,5666名甲状腺癌患者与22,664名对照组患者的比例为1:4(图1a)。我们根据韩国国民健康保险服务数据库2002年至2015年的队列数据(研究I,n= 28,330)和2002年至2019年的全部数据(研究II,n= 88,3074),并进行各种协变量的逻辑回归和亚组分析。

结果:在研究I中,甲状腺功能减退、甲状腺炎、自身免疫性甲状腺炎、甲状腺功能亢进和Graves病与甲状腺癌呈正相关。在研究II中,调整包括甲状腺功能检查次数在内的协变量后,所有甲状腺疾病中甲状腺癌的OR值均显著降低。甲状腺功能减退、甲状腺炎和自身免疫性甲状腺炎呈正相关(调整的优势比,OR(95%置信区间,CI)分别为1.28(1.25-1.32)、1.36(1.31-1.42)和1.17(1.11-1.24))。而甲状腺功能亢进和Graves病与甲状腺癌呈负相关(调整后OR (95% CI)分别为0.80(0.77-0.83)和0.69(0.65-0.74))。两项研究的多个亚组分析显示了一致的结果。

表1 甲状腺功能减退、甲状腺功能亢进、甲状腺炎、自身免疫性甲状腺炎和Graves病中甲状腺癌的比值比(95%置信区间)

图1 研究I分组分析中甲状腺癌的调整优势比:(A)年龄、性别、收入和居住地区,(B)甲状腺功能减退、甲状腺机能亢进、甲状腺炎、自身免疫性甲状腺炎和Graves病,(C)体重指数肥胖、吸烟状况和饮酒频率,以及(D)CCI、总胆固醇、收缩压,图2。研究I分组分析中甲状腺癌的调整优势比(B)、甲状腺功能亢进、甲状腺炎、自身免疫性甲状腺炎和Graves病,(C)体重指数、吸烟状况和饮酒频率,以及(D)CCI、总胆固醇、SBP,图2。这些指标包括:(1)体重指数(BMI)、吸烟状况和饮酒频率;(4)CCI、总胆固醇、收缩压(SBP)、舒张压(DBP)和空腹血糖。CCI,Charlson共病指数;SBP,收缩压;DBP,舒张压。

图2 在研究II的亚组分析中调整了甲状腺癌的优势比。亚组分析按(A)年龄、性别、收入和居住地区,(B)甲状腺功能减退、甲亢、甲状腺炎、自身免疫性甲状腺炎和Graves病,(C)按体重指数、吸烟状况和饮酒频率肥胖,(D)CCI、总胆固醇、SBP、DBP和空腹血糖。CCI,Charlson共病指数;SBP,收缩压;DBP,舒张压。

结论:在这项大规模的以人群为基础的全国性研究中,我们证实了甲状腺疾病的检查结果导致了对甲状腺功能障碍和甲状腺炎与甲状腺癌风险过高的估计。

原文出处:

Song YS,  Kim KS,  Kim SK,et al.Screening Leads to Overestimated Associations of Thyroid Dysfunction and Thyroiditis with Thyroid Cancer Risk.Cancers (Basel) 2021 Oct 27;13(21) 

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    2022-03-27 anminleiryan
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    2022-01-11 sjq027
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    2021-12-25 ms3000001763302457

    真的与碘有关系了

    0

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