摘要: 目的：探讨甲状腺激素在乳腺癌中的诊断价值，为乳腺癌的早期诊断及明确诊断提供依据。方法：纳入2019年9月至2021年9月就诊于我院的236例女性为研究对象，根据是否患乳腺癌分为乳癌组(116例)、对照组(120例)。收集两组患者年龄、身高、体重等一般资料。计算体质指数(body mass index, BMI) = 体重(kg)/身高(m2)。罗氏全自动生化分析仪检测胆固醇(TC)、甘油三脂(TG)等肝肾功、血脂指标。电化学发光免疫测定法检测甲状腺功能指标。Spearman法分析TSH、FT3、FT4与乳腺癌最大直径及淋巴结转移的相关性。Logistic回归分析乳腺癌的影响因素。采用受试者工作特征曲线(receiver operating characteristic, ROC)分析甲状腺激素在乳腺癌患者中的诊断价值。结果：乳癌组与对照组相比，年龄、BMI、WHR等基线资料比较差异无统计学意义[52 (49, 58) vs (53 ± 10)；25 (23, 27) vs 25 (22, 27)，0.90 (0.85, 0.95) vs 0.89 (0.82, 0.94)，均P > 0.05]。乳腺癌组TG、TC高于对照组[1.56 (1.10, 2.07) vs 1.18 (0.84, 1.40)；(4.80 ± 1.06) vs 4.27 (3.98, 4.6)，均P < 0.05]。乳癌组TSH高于对照组[3.26 (2.12, 6.51) vs 2.49 (1.77, 3.60), P < 0.05]，FT4低于对照组[(14.49 ± 3.39) vs (16.47 ± 2.54), P < 0.05]。乳腺癌分层比较，与I~II期相比、III~IV期TSH、FT3、FT4差异无统计学意义[3.09 (2.09, 6.33) vs 4.44 (2.23, 17.24)；4.53 (4.09, 4.96) vs (4.12 ± 1.08)；(14.61 ± 3.19) vs (13.80 ± 4.43)，均P > 0.05]。Spearman相关性分析显示，乳腺癌最大直径与TSH (r = 0.203, P = 0.029)呈正相关；淋巴结转移与TSH (r = 0.189, P = 0.042)呈正相关，与FT4 (r = −0.345, P = 0.000)负相关。Logistic回归结果显示，TC (OR: 2.031)、TG (OR: 2.318)、TSH (OR: 1.257)升高是乳腺癌发生的危险因素，FT4 (OR: 0.807)降低是乳腺癌的危险因素。FT4诊断乳腺癌的受试者工作特征曲线(ROC)显示，TSH诊断乳腺癌的AUC为0.642，截断值为4.055 mIU/L，敏感度为0.414，特异度为0.942；FT4诊断乳腺癌的AUC为0.691，截断值为15.475 pmmol/L，敏感度为0.647，特异度为0.675。结论：TSH升高、FT4降低是乳腺癌发生的危险因素。当TSH > 4.055 mIU/L时，为乳腺癌的明确诊断提供依据；当FT4 < 15.475 pmmol/L时，为乳腺癌的早期诊断提供依据。
Abstract:
Objective: To explore the diagnostic value of thyroid hormone in breast cancer, and to provide basis for early diagnosis and definite diagnosis of breast cancer. Methods: 236 women in our hospital from September 2019 to September 2021 were included as the research objects. They were divided into the breast cancer group (116 cases) and the control group (120 cases) according to whether they had breast cancer or not. The age, height, weight and other general data of the two groups were collected. Calculate body mass index (BMI) = weight (kg)/height (m2). Roche automatic biochemical analyzer detects cholesterol (TC), triglyceride (TG) and other indexes of liver and kidney function and blood lipid. The indexes of thyroid function were detected by electrochemiluminescence im-munoassay. Spearman method was used to analyze the correlation between TSH, FT3, FT4 and the maximum diameter and lymph node metastasis of breast cancer. Logistic regression was used to analyze the influencing factors of breast cancer. Receiver operating characteristic (ROC) was used to analyze the diagnostic value of thyroid hormone in patients with breast cancer. Results: There was no significant difference in baseline data such as age, BMI, and WHR between the breast cancer group and the control group [52 (49, 58) vs (53 ± 10); 25 (23, 27) vs 25 (22, 27), 0.90 (0.85, 0.95) vs 0.89 (0.82, 0.94), both P > 0.05]. The TG and TC of the breast cancer group were higher than those in the control group [1.56 (1.10, 2.07) vs 1.18 (0.84, 1.40); (4.80 ± 1.06) vs 4.27 (3.98, 4.6), all P < 0.05]. TSH in breast cancer group was higher than that in control group [3.26 (2.12, 6.51) vs 2.49 (1.77, 3.60), P < 0.05], and FT4 was lower than that in control group [(14.49 ± 3.39) vs (16.47 ± 2.54), P < 0.05]. There was no significant difference in TSH, FT3 and FT4 between stage I~II and stage III~IV breast cancer [3.09 (2.09, 6.33) vs 4.44 (2.23, 17.24); 4.53 (4.09, 4.96) vs (4.12 ± 1.08); (14.61 ± 3.19) vs (13.80 ± 4.43), both P > 0.05]. Spearman correlation analysis showed that the maximum diameter of breast cancer was positively correlated with TSH (r = 0.203, P = 0.029); Lymph node metastasis was positively correlated with TSH (r = 0.189, P = 0.042) and negatively correlated with FT4 (r = −0.345, P = 0.000). Logistic regression results showed that the increase of TC (OR: 2.031), TG (OR: 2.318) and TSH (OR: 1.257) was the risk factor of breast cancer, and the de-crease of FT4 (OR: 0.807) was the risk factor of breast cancer. The receiver operating characteristic curve (ROC) of breast cancer diagnosed by FT4 showed that the AUC of breast cancer diagnosed by TSH was 0.642, the cut-off value was 4.055 mIU/L, the sensitivity was 0.414, and the specificity was 0.942; The AUC of FT4 in the diagnosis of breast cancer was 0.691, the cut-off value was 15.475 pmmol/l, the sensitivity was 0.647, and the specificity was 0.675. Conclusion: The increase of TSH and the decrease of FT4 are the risk factors of breast cancer. When TSH > 4.055 mIU/L, it provides a basis for the definite diagnosis of breast cancer; When FT4 < 15.475 pmmol/L, it can provide basis for early diagnosis of breast cancer.