摘要
目的探讨彩色多普勒超声联合甲状腺自身抗体检测对早期诊断甲状腺癌的临床意义。方法回顾性选取绍兴市中心医院医共体总院2019年9月至2021年9月诊治的108例甲状腺癌患者(研究组)和108例同期甲状腺良性病变患者(对照组)为研究对象,两组患者均行彩色多普勒超声检查及甲状腺自身抗体检测,比较两组超声检查结果及入院时血清甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺受体抗体(TRAb)水平,采用Spearman相关和受试者工作特征(ROC)曲线分析上述指标与甲状腺癌病理特征的关系及对早期甲状腺癌的诊断价值。结果研究组超声图像特征主要表现为边缘不清晰、低回声、形态不规整、血流分布杂乱、内部有微小钙化、无包膜、血流阻力指数≥0.7。超声检查对于甲状腺癌诊断的灵敏度为86.11%(93/108),特异度为87.18%(102/117),准确率为90.28%(195/216)。研究组血清TgAb、TPOAb、TRAb水平高于对照组[(32.28±2.85)kU/L比(21.96±2.54)kU/L、(81.28±7.32)kU/L比(51.53±5.86)kU/L、(4.48±1.25)U/L比(2.35±0.63)U/L],差异有统计学意义(P<0.05)。研究组发生淋巴结转移患者血清TgAb、TPOAb、TRAb水平高于未发生淋巴结转移患者[(36.28±3.12)kU/L比(30.60±2.54)kU/L、(93.51±8.57)kU/L比(76.13±6.62)kU/L、(5.73±1.54)U/L比(3.95±1.12)U/L](P<0.05);研究组Ⅲ~Ⅳ期患者血清TgAb、TPOAb、TRAb水平高于Ⅰ~Ⅱ期患者[(35.84±3.28)kU/L比(29.74±2.29)kU/L、(89.35±8.16)kU/L比(75.52±6.23)kU/L、(5.28±1.49)U/L比(3.91±1.25)U/L](P<0.05)。Spearman相关性分析结果显示,甲状腺癌患者血清TgAb、TPOAb、TRAb水平与淋巴结转移呈正相关(r=0.758、0.824、0.695,P<0.05),与临床分期呈正相关(r=0.735、0.796、0.673,P<0.05)。ROC曲线分析结果显示,超声检查联合TgAb、TPOAb、TRAb检测对甲状腺癌早期诊断的曲线下面积为0.930,灵敏度为85.19%,特异度为91.67%,联合诊断价值优于单一诊断。结论超声检查联合血清TgAb、TPOAb、TRAb检测对于早期甲状腺癌具有较高的诊断价值,可为术前诊断及制定个体化治疗方案提供依据。
Objective To investigate the clinical significance of color Doppler ultrasonography combined with detection of thyroid autoantibodies in the early diagnosis of thyroid cancer.Methods A total of 108 patients with thyroid cancer who treated in Shaoxing Central Hospital Medical Community General Hospital from September 2019 to September 2021 were selected as the research group,and 108 patients with benign thyroid lesions during the same period were selected as the control group.The ultrasound examination results and the levels of serum thyroglobulin antibody(TgAb),thyroid peroxidase antibody(TPOAb)and thyroid receptor antibody(TRAb)were compared between the two groups.The relationship between the thyroid autoantibodies index and the early diagnosis of thyroid cancer were analyzed by Spearman correlation analysis;the value of early diagnosis by color Doppler ultrasonography combined with detection of thyroid autoantibodies were evaluated by the receiver operating characteristic(ROC)curve.Results The main features of ultrasonic images in the research group were unclear edge,low echo,irregular shape,chaotic blood flow distribution,internal micro calcification,no envelope and blood flow resistance index≥0.7.The sensitivity of ultrasonography for the diagnosis of thyroid cancer was 86.11%(93/108),the specificity was 87.18%(102/117)and the accuracy was 90.28%(195/216).The levels of serum TgAb,TPOAb and TRAb in the research group were higher than those in control group:(32.28±2.85)kU/L vs.(21.96±2.54)kU/L,(81.28±7.32)kU/L vs.(51.53±5.86)kU/L,(4.48±1.25)U/L vs.(2.35±0.63)U/L,there were statistical differences(P<0.05).The levels of serum TgAb,TPOAb and TRAb in patients with lymph node metastasis were higher than those in the patients without lymph node metastasis:(36.28±3.12)kU/L vs.(30.60±2.54)kU/L,(93.51±8.57)kU/L vs.(76.13±6.62)kU/L,(5.73±1.54)U/L vs.(3.95±1.12)U/L,there were statistical differences(P<0.05).The levels of serum TgAb,TPOAb and TRAb in patients with stageⅢ-Ⅳwere higher than those in the patients with stageⅠ-Ⅱ:(35.84±3.28)kU/L vs.(29.74±2.29)kU/L,(89.35±8.16)kU/L vs.(75.52±6.23)kU/L,(5.28±1.49)U/L vs.(3.91±1.25)U/L,there were statistical differences(P<0.05).The results of Spearman correlation analysis showed that the levels of serum TgAb,TPOAb and TRAb were positively correlated with lymph node metastasis(r=0.758,0.824,0.695,P<0.05)and clinical stage of thyroid cancer(r=0.735,0.796,0.673,P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of ultrasound examination combined with TgAb,TPOAb and TRAb for early diagnosis of thyroid cancer was 0.930,the sensitivity was 85.19%,and the specificity was 91.67%.The combined diagnostic value was better than single diagnosis.Conclusions Ultrasound examination combined with serum TgAb,TPOAb and TRAb has high diagnostic value for early stage thyroid cancer,which is helpful to clinically clarify the condition,and provides a reliable basis for preoperative diagnosis and targeted individualized treatment plan.
作者
阮郑
白奇峰
钟海燕
Ruan Zheng;Bai Qifeng;Zhong Haiyan(Department of Ultrasound,Shaoxing Central Hospital Medical Community General Hospital,Shaoxing 312030,China)
出处
《中国医师进修杂志》
2023年第8期731-735,共5页
Chinese Journal of Postgraduates of Medicine
关键词
超声检查
多普勒
彩色
甲状腺肿瘤
自身抗体
诊断
鉴别
Ultrasonography,Doppler,color
Thyroid neoplasms
Autoantibodies
Diagnosis,differential
作者简介
通信作者:阮郑,Email:1736297893@qq.com。
