摘要目的 观察不同水碘地区甲状腺肿瘤患者血清促甲状腺激素(TSH)水平,探讨血清TSH水平在甲状腺肿瘤诊断中的意义.方法 采用生态学研究方法,在山东省菏泽市所属单县、曹县、牡丹区3个县区的医院,收集甲状腺肿瘤患者的病历资料,包括一般情况、血清TSH水平、病理报告等.利用水碘监测数据对病历患者所在地区进行分类,并按照病理报告分为甲状腺癌患者和良性肿瘤(非甲状腺癌)患者,比较其血清TSH水平;按血清TSH水平(＜0.38、0.38～1.50、＞1.50 ～ 2.50、＞2.50 ～ 5.57、＞5.57 mU/L)分组,分析甲状腺癌患者构成;采用Spearman等级相关分析水碘与甲状腺肿瘤患者TSH水平的相关性.结果 甲状腺癌患者(n=190)血清TSH的中位数(M)为2.55 mU/L,范围为(0.10 ～ 20.46)mU/L,显著高于非甲状腺癌患者[n=549,M=2.24mU/L,范围为(0.01～ 24.90)mU/L],二者比较差异有统计学意义(Z=-2.33,P＜0.05).按血清TSH水平(＜0.38、0.38～1.50、＞1.50～ 2.50、＞2.50 ～ 5.57、＞5.57 mU/L)分组,甲状腺癌患者构成比有随着TSH水平的增加而升高的趋势,分别为21.6％(8/37)、21.2％(39/184)、25.8％(46/178)、27.8％ (64/230)和30.4％ (34/112),但组间比较,差异无统计学意义(x2=4.086,P＞0.05).水碘与甲状腺肿瘤患者血清TSH水平间存在正相关关系[相关系数(rs)=0.539,P＜ 0.05].结论 在水源性高碘地区,甲状腺肿瘤患者术前血清中TSH水平对于诊断甲状腺良恶性肿瘤具有参考价值.

abstractsObjective We investigated serum thyroid-stimulating hormone (TSH) concentrations in patients who had been diagnosed thyroid tumors in areas with different iodine levels in drinking water.We evaluated the significance of serum TSH levels in thyroid tumors.Methods An ecological study of patients from Heze Municipal Hospital,Shanxian Central Hospital and Caoxian People's Hospital was implemented.Variables included age at diagnosis,gender,TSH level,final histology (benign versus cancer),and iodine concentrations in the drinking water.We compared the serum TSH levels of patients with benign and malignant thyroid tumors.The patients were divided into 5 groups based on serum TSH (＜ 0.38,0.38-1.50,＞ 1.50-2.50,＞ 2.50-5.57,and ＞ 5.57 mU/L),and we analyzed the constituent ratio of patients with thyroid cancer.We analyzed the correlation between serum TSH levels of patients with thyroid cancer and iodine concentrations in the drinking water by the statistical method of Spearman rank correlation.Results Thyroid cancer patients (n =190) had higher serum TSH levels [2.55 (0.10-20.46) mU/L vs 2.24 (0.01-24.90) mU/L,Z =-2.33,P ＜ 0.05] as compared to those with no malignancy (n =549).The patients were divided into 5 groups of patients each based on serum TSH:＜ 0.38,0.38-1.50,＞ 1.50-2.50,＞ 2.50-5.57 and ＞ 5.57 mU/L;the constituent ratio of malignant tumor increased with increasing TSH concentration,with respective rates of 21.6％ (8/37),21.2％ (39/184),25.8％ (46/178),27.8％ (64/230),and 30.4％ (34/112)in the 5 groups,but there was no significant difference (x2 =4.086,P ＞ 0.05).There was a positive correlation between serum TSH levels of patients and iodine in drinking water (rs =0.539,P ＜ 0.05).Conclusion Our study has supported an association between preoperative TSH levels and risk of malignant tumors in patients who had been diagnosed thyroid tumors in areas with high water iodine levels.