分化型甲状腺癌患者术后血清微小RNA-21含量评判预后的临床价值  

Clinical value of miRNA-21 level on prognosis evaluation for patients with differentiated thyroid cancer after surgery

作　　者：曹礼荣[1] 王玉云[1] 邱涵[2] 王薇[2] 

机构地区：[1]湖北中医药高等专科学校,湖北荆州434020 [2]华中科技大学附属荆州市中心医院,湖北荆州434020

出　　处：《现代中西医结合杂志》2016年第12期1264-1267,1314,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨血清微小RNA-21(miRNA-21)含量评估分化型甲状腺癌(DTC)术后患者复发/转移、识别高危风险患者的临床价值。方法收集DTC患者及良性甲状腺结节患者(作为良性结节组)的一般情况、个人史、家族遗传史、职业暴露史、相关既往史等基本情况,并测定血清促甲状腺激素(TSH)、癌胚抗原(CEA)、降钙素(CT)、抗甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体(TG-Ab)、甲状腺球蛋白(TG)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、细胞角蛋白多肽-19(CK-19)及miRNA-21含量。所有DTC患者均术后常规随访2年,依据随访是否出现不良预后事件分为健康组及不良预后组。比较3组患者上述观察指标的差异性,使用多因素Logistic回归分析得出影响结局的独立危险因素,使用皮尔逊积矩相关系数(PPMCC)分析miRNA-21与其他独立危险因素是否具有相关性,通过受试者工作特征曲线(ROC curve)评估该指标对于DTC患者不良预后的预测价值及临界值;根据其预测临界值,将DTC患者分为临界值以上组及以下组,使用卡普兰-迈耶曲线(KM curve)验证2组患者不良预后发生率是否具有差异性,从而识别高危风险的DTC患者。结果健康组51例、不良预后组10例、良性结节组57例,3组间HT病史、GD病史、职业暴露史、家族遗传史及血清TPO-Ab、TG-Ab、TG、CT、CEA、CK-19、miRNA-21水平比较差异均有统计学意义(P均<0.05);多因素Logistic回归显示TPO-Ab、TG-Ab、CT、CK-19、miRNA-21是DTC患者术后2年内发生不良预后事件的独立危险因素;其中miRNA-21与TPO-Ab、CT、CK-19均呈正相关(r=0.538,0.604,0.522,P均<0.05),与TG-Ab无显著相关性(r=0.371,P>0.05);该指标ROC曲线的AUC为0.748,95%CI(0.707,0.814),最佳预测值为8.19 ng/m L;根据miRNA-21的最佳预测值,临界值以上的DTC术后患者2年内并发不良预后事件的比率明显增高(P<0.05),KM生存曲线亦证实上述研究结果�Objective It is to investigate the clinical value of miRNA- 21 level on the evaluation for recurrence and metastasis of differentiated thyroid carcinoma（ DTC） and the recognition of the high risk patients. Methods The basic information of DTC patients and benign thyroid nodules patients include general situation,personal history,family history,occupational exposure,related past history were collected,and the levels of thyroid stimulation hormone（ TSH）,carcinoembryonic antigen（ CEA）,calcitonin（ CT）,anti-thyroid peroxidase antibodies（ TPO- Ab）,thyroglobulin antibodies（ TG- Ab）,thyroglobulin（ TG）,three free triiodothyronine（ FT3）,free four triiodothyronine（ FT4）,cytokeratin polypeptides- 19（ CK-19） and miRNA- 21 were detected in all patients. All DTC patients were divided into health group and poor prognosis group according to the results of follow-up for 2 years. The data were compared among the three groups. The independent risk factors of affect the outcome were analyzed by multivariate logistic regression analysis; the correlation of miRNA- 21 and other independent risk factors were analyzed by Pearson product moment correlation coefficient（ PPMCC） analysis; the predictive value and critical value of these indexes on poor prognosis of DTC patients were evaluated by the receiver operating characteristic（ ROC） curve; and based on its prediction of critical value,the evaluation value on the incidence of poor prognosis were verified by the Kaplan-Meier（ KM） curve. Results There was 51 cases in healthy group,10 cases in poor prognostic group and 57 cases in thyroid nodules group. There were significant differences among the three groups in HT history,GD history,occupational exposure history,family history,and the levels of TPO- Ab,TG- Ab,TG,CT,CEA,CK- 19,miRNA- 21（ all P 0. 05）. Multivariate Logistic regression analysis showed that the levels of TPO- Ab,TG- Ab,CT,CK- 19 and miRNA- 21 was an independent risk factor for poor prognosis in patients with DTC events a

关 键 词：分化型甲状腺癌 微小RNA 不良预后 

分 类 号：R736.1[医药卫生—肿瘤]