分化型甲状腺癌术后首次^(131)I治疗前刺激性Tg水平与转移灶的关系  

The relationship between first pre-ablation sTg levels and metastasis in postoperative patients with differentiated thyroid carcinoma

作　　者：刘永[1] 陈鹏[1] 宋长祥[1] 陆武[1] 杜鹏[1] 

机构地区：[1]连云港市第一人民医院核医学科,江苏连云港222002

出　　处：《中国临床医学影像杂志》2017年第7期471-474,共4页Journal of China Clinic Medical Imaging

基　　金：连云港市卫生计生科技项目(201610)

摘　　要：目的:探讨刺激性甲状腺球蛋白(Stimulated thyroglobulin,s Tg)、s Tg/促甲状腺激素(Thyrotropin,TSH)比值在分化型甲状腺癌(Differentiated thyroid carcinoma,DTC)术后首次^(131)I治疗前对转移的预测价值。方法 :106例行甲状腺全切术及颈淋巴结清扫术的DTC患者,首次^(131)I治疗前1 d测s Tg、TSH水平,^(131)I治疗后5~7 d行^(131)I-SPECT/CT显像。根据是否存在转移,将所有病例分为无转移组(M0)和转移组(M1),比较两组间s Tg、s Tg/TSH比值有无差异,并通过ROC曲线及最佳诊断界值点(Diagnostic critical point,DCP)评估s Tg、s Tg/TSH比值预测转移的价值。结果 :M0和M1组的s Tg范围分别为0.47~9.57 ng/m L和27.10~462.00 ng/m L,2组的Tg/TSH比值则分别为0.00~0.09 ng/U和0.29~4.78 ng/U。2组间的s Tg、Tg/TSH相比均有统计学意义(Mann-Whitney秩和检验:Tg:P=0.000(U=242.50);Tg/TSh:P=0.000(U=237.50)。s Tg、s Tg/TSH比值的ROC曲线下面积分别为0.913、0.914,DCP分别为40.60 ng/m L、0.24 ng/U,灵敏度、特异度、准确度分别为70.21%、100%、86.79%和80.85%、94.92%、88.68%。结论 :首次^(131)I治疗前检测s Tg、s Tg/TSH比值对预测甲状腺癌转移有重要的意义。Objective： To investigate the relationship between first pre-ablation stimulated thyroglobulin（sTg） and sTg/thyrotropin（TSH） levels and metastasis in postoperative patients with differentiated thyroid carcinoma（DTC）. Methods： The study included 106 patients with DTC who had undergone total thyroidectomy and lymphadenectomy. The pre-ablation sTg and TSH of 106 patients were measured one day before first 131I ablation therapy, and the patients undergone 131I-SPECT/CT on 5～7 days after 131I ablation therapy. Patients were divided into two groups as M0 group and M1 group according to the presence and absence of metastases, respectively. The sTg and sTg/TSH value between M0 and M1 were compared by Mann-Whitney rank-sun test. The ROC curves and diagnostic critical point（DCP） were analyzed to evaluate the predictive values of sTg and sTg/TSH. Results： The pre-ablation sTg and sTg/TSH of M1 were significantly higher than those of M0（U=242.50, P=0.000; U=237.50, P=0.000）. Areas under the ROC curve for sTg and sTg/TSH was 0.913 and 0.914. The cut-off values of DCP of sTg and sTg/TSH were 40.60 ng/mL with a sensitivity of 70.21%, specificity of 100%, accuracy of 86.79%, and 0.24 ng/U with a sensitivity, of 80.85%, specificity of 84.92%, accuracy of 88.68%. Conclusion： The pre-ablation sTg and sTg/TSH may be a useful diagnostic marker for predicting metastases before the first 131I ablation therapy.

关 键 词：甲状腺肿瘤 体层摄影术 发射型计算机 单光子碘 

分 类 号：R736.1[医药卫生—肿瘤]