促甲状腺激素受体mRNA联合^(99m)Tc-MIBI显像诊断甲状腺结节良恶性的价值  

The Value of Imaging Diagnosis of Benign and Malignant Thyroid Nodule by Thyroid-stimulating Hormone Receptor mRNA Combined with ^(99m)Tc-MIBI Imaging

作　　者：刘佳[1] 付鹏[1] 杨志杰[1] 高慧棋[1] 路宇[1] 

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001

出　　处：《肿瘤学杂志》2016年第5期384-388,共5页Journal of Chinese Oncology

摘　　要：[目的]探讨促甲状腺激素受体(thyroid-stimulating hormone receptor,TSHR)mRNA联合^(99m)Tc-MIBI显像诊断良恶性甲状腺结节的价值。[方法 ]对55例^(99m)TcO_4^-显像示为"冷"或"凉"结节的患者行^(99m)Tc-MIBI亲肿瘤显像,同时采集其肘静脉血,利用荧光实时定量逆转录聚合酶链式反应(RT-PCR)检测其外周循环血中TSHR mRNA表达水平。两种检查方法联合分析并与患者术后病理结果比较。分别计算以上2种方法联合应用对诊断甲状腺结节的敏感性、特异性、准确性、阳性预测值和阴性预测值。并采用卡方检验,将联合应用后的结果分别与单一方法进行比较。[结果]55例患者术后病理证实23例恶性,32例良性。^(99m)Tc-MIBI显像的敏感性60.87%,特异性81.25%,准确性72.72%,阳性预测值70.00%,阴性预测值74.29%。TSHR mRNA表达水平检测敏感性73.91%,特异性87.50%,准确性81.82%,阳性预测值80.95%,阴性预测值82.35%。两种方法联合诊断良恶性甲状腺结节的敏感性95.65%,特异性81.25%,准确性87.27%,阳性预测值78.57%,阴性预测值96.30%。与^(99m)Tc-MIBI亲肿瘤显像比较,两种方法合用敏感性显著高于^(99m)Tc-MIBI亲肿瘤显像(P=0.047),差异具有统计学意义,准确性高于^(99m)Tc-MIBI亲肿瘤显像单一应用,但差异无统计学意义(P>0.05)。[结论]TSHR mRNA检测与^(99m)Tc-MIBI亲肿瘤显像联合应用能够更准确判断甲状腺结节的性质,指导临床治疗方案确定。[Objective ] To investigate the value of detection of thyroid-stimulating hormone recep- tor （TSHR） mRNA combined with 99mTc-MIBI imaging on the diagnosis of benign and malignant thyroid nodules. [Methods] Fifty-five patients with cold or cool thyroid nodules under 99nfTcO4- imaging underwent 99nfTc-MIBI scintigraphy .At the same time, TSHR mRNA expression level of peripheral circulating blood was detected by reverse transcriptase polymerase chain reaction（RT- PCR）. The result of combination detection of the two methods was compared with pathology. The sensitivity ,specificity and accuracy of combined detection of the two methods to diagnose the thyroid nodules were calculated,which were compared with result of single detection. [Results] Postoperative pathology confirmed 23 cases of malignant lesions, 32 cases of benign lesions. The sensitivity,specificity and accuracy were 60.87% ,81.25% and 72.72% in 99nfTc-MIBI thyroid scintigraphy;and were 73.91% ,87.50% and 81.82% in TSHR mRNA detection; and were 96.65% ,81.25% and 82.27% in combined detection for the diagnosis of thyroid nodules. The sensitivity of combination detection was higher than that of 99nfTc-MIBI thyroid scintigraphy,with significant difference （P〈0.05）, and the accuracy was also higher,but no significant difference was found （PM）.05）. [Conclusion] Combination of 99nfTc-MIBI imaging and TSHR mRNA detection might diagnose the thyroid nodules accurately to determine the management.

关 键 词：甲状腺结节 99MTC-MIBI显像 促甲状腺激素受体 mRNA 

分 类 号：R730.44[医药卫生—肿瘤] R736.1[医药卫生—临床医学]