The Predictive Value Of Plasma ApoE Combined With Lipid Metabolism And Thyroid Function On The Occurrence And Development Of PTC

Objective:To explore the biological correlation between plasma apolipoprotein E（APOE）,lipid metabolism index,thyroid function and thyroid papillary carcinoma（PTC）and lymph node metastasis（LNM）.To study the risk factors affecting the patients with advanced PTC and their predictive value,and to explore the relevant factors affecting the plasma Apo E level,so as to provide the basis for APOE as the diagnosis or targeted treatment of PTC.Methods:The clinical data of 161 patients with PTC（PTC group）and31 patients with nodular goiter（benign control group）confirmed by histopathology after surgical treatment in the Department of Otolaryngology Head and Neck Surgery of the First Affiliated Hospital of Hebei North University from September 2019 to September 2022 were analyzed retrospectively.According to the postoperative pathological results,the patients with PTC were divided into LNM group（51 cases）and simple PTC group（110 cases）.Determination of Apo E protein concentration in patients’plasma by enzyme-linked immunosorbent assay（ELISA）.According to the median concentration of Apo E protein,the patients were divided into high level group（80 cases）and low level group（81 cases）,and then the related factors affecting the plasma Apo E level were discussed.Chi-square test,independent sample t-test,Mann-Whitney U test and multivariate logistic regression model were used to analyze the relationship between the baseline data,lipid metabolism related indicators,thyroid functionand,Apo E protein concentration and PTC and LNM between the two groups（PTC group and benign control group,simple PTC group and LNM group）.The ROC curve was drawn to evaluate the predictive value of Apo E on the occurrence of PTC.Patients with PTC were divided into two groups according to clinical stages:early group（stage I and II）,late group（stage III and IV）,to further explore the relationship between lipid metabolism and late PTC and its predictive value.Results:1.In this study,161 patients with PTC and 31 patients with nodular goiter as the benign control group were included.Single factor analysis showed that the levels of Apo E and TSH in PTC group were significantly higher than those in benign control group（all P<0.05）,while FT₃,FT₄,Tg,HDL-C,Apo A1 were lower than those in benign control group（P<0.05）.Multivariate logistic analysis showed that Apo E,TSH,FT₄and Tg were the important influencing factors to predict the occurrence of PTC（all P<0.05）.The area under curve（AUC）of the joint prediction of Apo E and TSH for PTC is 0.682,which is larger than the AUC of Apo E and TSH alone,and its prediction value is the highest.2.Analysis of influencing factors of PTC lymph node metastasis:The univariate analysis results of simple PTC group（110 cases）and LNM group（51 cases）showed that Apo E,age,FT₃,FT₄,TMAb,LDL-C,Apo A1,Apo B,LP（a）,clinical stage were significantly correlated with the risk of LNM in PTC（all P<0.05）.Multivariate logistic analysis showed that Apo E,age,clinical stage,FT₄and TMAb were the influencing factors of LNM in PTC（P<0.05）.3.Analysis of influencing factors of plasma Apo E protein concentration:The univariate analysis results of 161 patients with PTC in APOE high level group（80 cases）and low level group（81 cases）showed that there were significant differences in the number of lymph node metastasis and TMAb between the two groups（P<0.05）.Multivariate logistic analysis showed that the increase in the number of lymph nodes was positively correlated with the increase in Apo E level（OR=1.291,95%CI:1.033～1.614,P=0.025）.4.Analysis of related factors affecting the clinical stage of PTC patients:The univariate analysis of early group（stage I,II）and late group（stage III,IV）of PTC patients showed that low levels of TCHO and LDL-C were significantly correlated with the occurrence of late PTC（P<0.05）.Multivariate logistic analysis showed that LDL-C was an independent influencing factor for the occurrence of late PTC（P<0.05）.The ROC curve shows that the AUC of LDC-C predicting late PTC is0.733,which has high predictive value.Conclusions:1.High level plasma Apo E is an independent risk factor for predicting the occurrence of PTC and its LNM,and has the potential to be a new biomarker for evaluating the occurrence of PTC and its LNM.The number of lymph node metastasis is an independent risk factor affecting the elevation of Apo E level.2.The indexes of lipid metabolism,TCHO and LDL-C,are the influencing factors of the occurrence of late PTC,and LDL-C has the highest value in predicting the occurrence of late PTC.3.Thyroid hormone TSH,FT4 and Tg are the influencing factors of the occurrence of PTC,and high level of TSH has an early warning effect on the occurrence of PTC.High level of FT₄is an important independent risk factor for lymph node metastasis of PTC,and TMAb is a protective factor for lymph node metastasis of PTC.4.With the decrease of age,PTC patients will increase the risk of lymph node metastasis.The higher the clinicopathological stage of patients,the greater the possibility of LNM.