甲状腺乳头状癌合并桥本甲状腺炎患者外周血T细胞亚群特征性的分析-东南大学学报医学版

甲状腺乳头状癌合并桥本甲状腺炎患者外周血T细胞亚群特征性的分析

单位：1. 天津医科大学, 天津 300052;
2. 天津医科大学总医院普通外科, 天津 300052

分类号：R736.1

出版年·卷·期（页码）：2020·39·第三期（341-347）

摘要：

目的:分析甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)的患者外周血T细胞亚群与甲状腺相关抗体及临床资料的相关性,探究PTC合并HT的患者T细胞亚群的特异性,并为其免疫状态提供参考。方法:选择2016年2月至2019年5月于天津医科大学总医院行手术治疗的100例PTC患者纳入此次研究,按其病理类型及是否合并桥本甲状腺炎分为PTC合并HT组(n=50)及单纯PTC组(n=50),用流式细胞术分析患者入院时外周血CD4⁺、CD8⁺T细胞亚群的比例,计算CD4⁺/CD8⁺T细胞比值,测定患者外周血甲状腺相关抗体,结合临床资料进行统计学分析。结果:两组患者性别占比差异有统计学意义(P<0.05);肿瘤腺外侵犯PTC组明显多于PTC合并HT组(P<0.05);淋巴结转移率PTC合并HT组多于PTC组(P<0.05); PTC组TgAb、TPOAb水平均明显低于PTC合并HT组(均P<0.05);PTC合并HT组T淋巴细胞亚群较单纯PTC组无明显变化,但CD4⁺/CD8⁺与临床分期相关。PTC合并HT组CD4⁺T细胞与TRAb呈负相关,CD8⁺T细胞与TRAb呈正相关,CD4⁺/CD8⁺与TRAb呈负相关(P<0.05),而PTC组则未显示有相关性。PTC合并HT组中低CD4⁺/CD8⁺亚组(CD4⁺/CD8⁺≤ 1.5)与高CD4⁺/CD8⁺亚组(CD4⁺/CD8⁺>1.5)相比,平均年龄和AJCC分期均偏低(P<0.05),而PTC组中低CD4⁺/CD8⁺亚组与高CD4⁺/CD8⁺亚组相比年龄和AJCC分期差异无统计学意义。结论:合并HT的低龄PTC患者外周血T细胞CD4⁺/CD8⁺值更小,肿瘤AJCC分期更低,提示细胞免疫水平对甲状腺乳头状癌的进展及预后有一定影响。

Objective:To analyze the correlation between peripheral blood T cell subsets and thyroid-related antibodies and clinical data in papillary thyroid carcinoma (PTC) patients accompanied by Hashimoto thyroiditis (HT), to explore the specificity of T cell subsets in patients with PTC and HT, and to provide a reference for their immune status. Methods:One hundred postoperative patients with papillary thyroid cancer in our hospital from February 2016 to May 2019 were included in this study. They were divided into PTC with HT group (n=50) and PTC group (n=50). The ratio of CD4⁺and CD8⁺ T cell subsets in peripheral blood of patients at admission was analyzed by flow cytometry, and the ratio of CD4⁺/CD8⁺ T cells was calculated. The peripheral blood thyroid-related antibodies were determined, then statistical analysis was performed combined with clinical data. Results:According to the analysis on basic clinical data, there was a difference in the sex ratio between PTC with HT group and PTC group (P<0.05); the PTC group with extraglandular tumor invasion was significantly more than that of the PTC with HT group (P<0.05); the lymph node metastasis rate of PTC with HT group was more than that of the PTC group (P<0.05). The levels of TgAb and TPOAb antibodies in the PTC group were significantly lower than those in the PTC with HT group (P<0.05). Among patients with PTC and HT, T lymphocyte subsets had no significant changes compared with patients only with simple PTC, but the CD4⁺/CD8⁺ratio was related to clinical stage. CD4⁺ T cells in the PTC with HT group were negatively correlated with TRAb, CD8⁺ T cells were positively correlated with TRAb, CD4⁺/CD8⁺ was negatively correlated with TRAb (P<0.05), while the PTC group showed no correlation. Analysis of the relationship between T cell subsets and clinical data in the two groups revealed that, in the PTC with HT group, the low CD4⁺/CD8⁺ subgroup (CD4⁺/CD8⁺ ≤ 1.5) had a lower average age and AJCC stage (P<0.05) in comparison with high CD4⁺/CD8⁺ subgroup (CD4⁺/CD8⁺>1.5). In the PTC group, there was no significant difference in age and AJCC stage between the two subgroup. Conclusion:The peripheral blood T cell CD4/CD8 ratio is smaller and tumor stage is lower in patients with HT at an younger age, suggesting that cellular immune level has a certain effect on the progression and prognosis of papillary thyroid carcinoma.

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