血清抗甲状腺球蛋白抗体对分化型甲状腺癌术后复发/转移的诊断价值  

Diagnostic value of serum thyroglobulin autoantibody on recurrence and/or metastasis following surgery in patients with differentiated thyroid carcinoma

作　　者：范群[1] 匡安仁[1] 袁耿彪[1] 

机构地区：[1]四川大学华西医院核医学科,成都610041

出　　处：《中华内分泌代谢杂志》2007年第6期494-497,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的评价甲状腺组织完全去除后当血清甲状腺球蛋白(TG)阴性时,抗甲状腺球蛋白抗体(TGAb)对分化型甲状腺癌(DTC)的诊断价值,确定TGAb的诊断临界点。方法选择169例术后病理诊断为DTC,残留甲状腺组织已完全去除,TG阴性、TGAb阳性的患者,将其分为:复发/转移组(A组)59例和无复发/转移组(B组)110例。以电化学发光法测定血清TG、TGAb水平,根据其TGAb值进行受试者丁作特征(ROC)曲线及不同阈值的阳性分层似然比分析。结果A组的TGAb值(1368±1343)IU/ml明显高于B组(154±539)IU/ml(P<0.01)。ROC曲线下面积为0.945(P<0.01),说明TGAb对这类患者具有较高的诊断价值。诊断临界点为204 IU/ml,其敏感度、特异度分别为91.50%、89.10%,与金标准相比较,诊断效率差异无统计学意义(P=0.143),吻合度较强(κ=0.785,P<0.01)。当验前概率固定且排除其它混杂因素作用,TGAb>1000 IU/ml发生复发/转移的可能性为204 IU/ml≤TGAb≤1000 IU/ml的1.12倍、100 IU/ml≤TGAb<204 IU/ml的4.03倍、10 IU/ml≤TGAb<100 IU/ml的24.79倍。结论TGAb可作为监测术后残留甲状腺组织已完全去除且TG阴性TGAb阳性DTC患者发生复发/转移的指标,其诊断临界点为204 IU/ml。TGAb值越高,发生复发/转移的可能性越大。Objective To evaluate the clinical significance of serum thyroglobulin autoantibody （TGAb） in thyroglobulin （TG）-negative and TGAb-positive patients with differentiated thyroid carcinoma （DTC） after thyroid ablation and ascertain the optimal operating point （OOP） of TGAb. Methods A total of 169 patients with histologically confirmed DTC and thyroid remnant ablation showed TG-negative and TGAb-positive results which were assessed by eleetroehemiluminescence immunoassay （ECLIA）. The cases were divided into group A （59 cases） and group B （110 eases） with or without evidence of recurrence or metastasis, respectively. The receiver operating characteristic （ ROC ） curve and positive likelihood ratio of different threshold values were analysed according to their serum TGAb level. Results Serum TGAb level （ 1 368 ± 1 343 ） IU/ml in group A was significantly higher than that （ 154 ± 539） IU/ml in group B （ P 〈 0.01 ）. The area under the ROC curve was 0. 945 and its asymptotic 95 % CI was （ 0. 911,0. 978 ）, with a higher diagnostic value. The OOP of TGAb was determined at 204 IU/ml with sensitivity of 91.50% and specificity of 89. 10%. McNemar test showed that the diagnostic results of the two methods were not statistically significant （ P = 0. 143 ）. Measure of agreement （κ） was 0. 785 （P 〈0.01 ）, showing the agreement of the two diagnostic methods. When the pre-test probability was fixed and the mixed function of other factors was excluded, the possibility of recurrence or metastasis as TGAb 〉 1 000 IU/ml was 1.12 times that of 204 IU/ml≤TGAb≤1 000 IU/ml, 4.03 times that of 100 IU/ml≤TGAb 〈204 IU/ml, 24.79 times that of 10 IU/ml ≤ TGAb 〈 100 IU/ml. Conclusion Serum TGAb level is a marker for recurrence or metastasis in TG-negative and TGAb-positive DTC patients undergone thyroideetomy and ^131Ⅰ ablation therapy. The OOP of TGAb level is 204 IU/ml. The higher the serum TGAb level, the more possibility of the recurrence and/or metastasis.

关 键 词：抗体 甲状腺球蛋白 甲状腺肿瘤 诊断临界点 

分 类 号：R736.1[医药卫生—肿瘤]