焦虑水平与甲状腺乳头状癌临床及病理特征的相关性研究

doi:10.16139/j.1007-9610.2025.03.10

摘要/Abstract

摘要：

目的：评估焦虑水平与甲状腺乳头状癌(PTC)病人各项临床及病理特征之间的关系。方法：2022年7月至2023年9月期间，在本中心接受手术治疗的病人中，有304例接受汉密尔顿焦虑量表(HAM-A)问卷调查，回顾性分析其临床及病理特征，并分析与焦虑水平的关系。结果：304例病人中，有271例经病理证实为PTC。其中75例处于较高的焦虑水平（根据HAM-A评分标准，≥14提示具有临床意义的焦虑症状），为焦虑组。单因素统计分析显示，焦虑组的甲状腺过氧化物酶抗体(TPOAb)异常升高的比例高于无焦虑组（34.7%比16.8%，P=0.002 4）。焦虑组肿瘤多灶性的比例也高于无焦虑组（33.3%比16.7%，P=0.004 4）。多因素Logistic回归分析证实焦虑水平与TPOAb异常升高及肿瘤多灶性相关（P=0.005 6，0.001 9）。结论：焦虑水平可能与PTC病人的TPOAb异常升高及肿瘤多灶性相关。

关键词: 甲状腺乳头状癌, 焦虑, 病理特征

Abstract:

Objective To evaluate the relationship between anxiety levels and clinicopathological characteristics in patients with papillary thyroid carcinoma (PTC). Methods Among the patients who underwent surgical treatment in our center from July 2022 to September 2023, 304 patients completed the Hamilton anxiety rating scale (HAM-A) questionnaire. The clinical and pathological characteristics of these patients and their association with anxiety levels were investigated. Results Among the 304 patients, 271 were pathologically confirmed to have PTC. Of the 271 patients, 75 had higher levels of anxiety (according to HAM-A scoring system, a score ≥14 indicates clinically significant anxiety) and were assigned to the anxiety group. Univariate statistical analysis showed that the proportion of patients with elevated thyroid peroxidase antibody (TPOAb) in the anxiety group was higher than that in the non-anxiety group (34.7% vs. 16.8%, P=0.002 4). Moreover, the proportion of patients with multifocal tumors in the anxiety group was also higher than that in the non-anxiety group (33.3% vs. 16.7%, P=0.004 4). Multivariate Logistic regression confirmed that anxiety levels were associated with elevated TPOAb (P=0.005 6) and tumor multifocality (P=0.001 9). Conclusions Anxiety levels may be related to elevated TPOAb and tumor multifocality in PTC patients.

Key words: Papillary thyroid carcinoma (PTC), Anxiety, Pathological characteristics

中图分类号:

R736.1

刘卓然, 赵起悟, 邱伟华, 严佶祺, 蔡伟, 匡洁. 焦虑水平与甲状腺乳头状癌临床及病理特征的相关性研究[J]. 外科理论与实践, 2025, 30(03): 241-246.

LIU Zhuoran, ZHAO Qiwu, QIU Weihua, YAN Jiqi, CAI Wei, KUANG Jie. The relationship between anxiety levels and clinicopathological characteristics in patients with papillary thyroid carcinoma[J]. Journal of Surgery Concepts & Practice, 2025, 30(03): 241-246.

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Item		PTC(n=271)	Other(n=33)	OR/χ² value	P value
Age(year)		37(31-45)	42(31-56)	χ²=2.6	0.1
	≥55	23(8.5)	9(27.3)	OR=0.2	0.003
	<55	248(91.5)	24(72.7)	OR=0.2	0.003
Gender	Male	76(28.0)	8(24.2)	OR=0.8	0.8
Gender	Female	195(72.0)	25(75.8)	OR=0.8	0.8
BMI		23.4(21.5-27.0)	22.9(21.2-25.4)	χ²=0.4	0.5
HAM-A score		9(4-14)	10(5-14)	χ²=0.1	0.75
	<14	196(72.3)	24(72.7)	OR=1.0	1.0
	≥14	75(27.7)	9(27.3)	OR=1.0	1.0
FT4		12.6(11.8-13.8) (n=264)	12.9(12.2-14.3) (n=31)	χ²=2.0	0.2
FT3		4.2(3.9-4.6) (n=264)	4.2(4.0-4.7) (n=31)	χ²=0.1	0.7
TSH		1.5(1.0-2.4) (n=264)	1.2(0.8-2.1) (n=31)	χ²=2.8	0.09
TG		12.5(5.0-23.5) (n=261)	62.8(7.5-229.0) (n=31)	χ²=15.9	0.000 07
TPOAb		1.0(0.4-2.6) (n=263)	0.9(0.4-1.9) (n=31)	χ²=0.1	0.7
TGAb		1.8(0.9-10.9) (n=264)	1.2(0.9-2.3) (n=31)	χ²=2.3	0.1

Item		Non-anxiety group (HAM-A<14) (n=196)	Anxiety group (HAM-A≥14) (n=75)	OR/χ² value	P value
Age		37(31-45)	38(32.5-44.5）	χ²=0.8	0.38
	≥55	15(7.7)	8(10.7)	OR=1.4	0.47
	<55	181(92.3)	67(89.3)	OR=1.4	0.47
Gender	Male	64(32.7)	12(16.0)	OR=2.5	0.006
Gender	Female	132(67.3)	63(84.0)	OR=2.5	0.006
BMI		23.5(21.5-26.7)	23.2(21.5-27.6)	χ²=0.01	0.92
FT4		12.6(11.8-13.8) (n=192)	12.4(11.7-13.9) (n=72)	χ²=0.01	0.90
FT3		4.2(3.9-4.5) (n=192)	4.2(3.9-4.6) (n=72)	χ²=0.6	0.43
TSH		1.5(1.1-2.5) (n=192)	1.4(0.8-2.2) (n=72)	χ²=2.1	0.15
TG		11.3(4.8-21.2) (n=190)	16.0(5.3-28.4) (n=71)	χ²=2.5	0.11
TPOAb		0.9(0.4-1.9) (n=191)	1.3(0.5-18.7) (n=72)	χ²=3.7	0.055
	Elevated	32(16.8) (n=191)	25(34.7) (n=72)	OR=2.6	0.002 4
	Normal	159(83.2) (n=191)	47(65.3) (n=72)	OR=2.6	0.002 4
TGAb		1.6(0.9-9.2) (n=192)	2.7(1.0-11.9) (n=72)	χ²=3.1	0.08
	Elevated	59(30.7) (n=192)	31(43.1) (n=72)	OR=1.7	0.08
	Normal	133(69.3) (n=192)	41(56.9) (n=72)	OR=1.7	0.08
BRAF	Mutant	141(87.0) (n=162)	54(85.7) (n=63)	OR=0.9	0.83
BRAF	Wild-type	21(13.0) (n=162)	9(14.3) (n=63)	OR=0.9	0.83
Tumor diameter（cm）		0.6(0.4-1.0) (n=192)	0.7(0.5-1.1)	χ²=1.2	0.28
Multifocality	Yes	32(16.7) (n=192)	25(33.3)	OR=2.5	0.004 4
Multifocality	No	160(83.3) (n=192)	50(66.7)	OR=2.5	0.004 4
Bilaterality	Yes	32(16.5) (n=194)	16(21.3)	OR=1.4	0.38
Bilaterality	No	162(83.5) (n=194)	59(78.7)	OR=1.4	0.38
Central LN metastasis	Yes	84(43.3) (n=194)	33(44.0)	OR=1.0	1.00
Central LN metastasis	No	110(56.7) (n=194)	42(56.0)	OR=1.0	1.00
Lateral LN metastasis	Yes	26(13.5) (n=192)	9(12.3) (n=73)	OR=1.1	1.00
Lateral LN metastasis	No	166(86.5) (n=192)	64(87.7) (n=73)	OR=1.1	1.00
Pathological subtypes	TCV or DSV	19(9.9) (n=192)	8(10.7)	OR=1.1	0.82
Pathological subtypes	Others	173(90.1) (n=192)	67(89.3)	OR=1.1	0.82

Item	Elevated TPOAb (n=57)	Normal TPOAb (n=206)	χ² value	P value
Psychic Anxiety socre	8(4-11)	5(3-8)	9.4	0.002
Somatic Anxiety score	4(1-7)	2(1-4)	5.4	0.02

Item	Multifocal (n=57)	Non-multifocal (n=210)	χ² value	P value
Psychic anxiety socre	7(3-11)	5(3-8)	3.4	0.066
Somatic anxiety score	3(1-7)	2(1-5)	2.7	0.098

Item	OR	Std. Error	z value	95% CI	P value
(Intercept)	0.89	1.22	-0.10	0.08-9.78	0.92
HAM-A score(≥14)	2.489	0.33	2.77	1.3-4.75	0.005 6
Age	0.97	0.02	-1.62	0.94-1.01	0.11
Gender(Female)	3.12	0.49	2.32	1.27-8.9	0.021
BMI	0.94	0.04	-1.41	0.87-1.02	0.16