血清TSH,TPOAb和TGAb水平在良恶性甲状腺结节中的鉴别诊断价值  

Diagnostic Value of Thyroid Autoantibodies and TSH in Thyroid Nodules

作　　者：李玉平[1] 王伦善[1] LI Yu-ping;WANG Lun-shan(Department of Clinical Laboratory,the 901th Hospital of the Joint Logistics Support Force of PLA,Hefei 230031,China)

机构地区：[1]中国人民解放军联勤保障部队第九○一医院检验科

出　　处：《现代检验医学杂志》2019年第5期93-97,共5页Journal of Modern Laboratory Medicine

摘　　要：目的研究促甲状腺激素(thyroid stimulating horomone,TSH)和甲状腺自身抗体(TPOAb,TGAb)在良恶性甲状腺结节中的鉴别诊断价值。方法采用回顾性调查研究方法,收集中国人民解放军联勤保障部队第九○一医院2013年3月~2018年9月期间因甲状腺结节行手术治疗且经病理证实的500例临床资料,其中分化型甲状腺癌(differentiated thyroid carcinoma,DTC)152例,甲状腺腺瘤(thyroid adenoma,TA)232例,结节性甲状腺肿(nodular goiter,NG)116例,并对检测结果进行统计分析。结果DTC组的TSH,TPOAb和TGAb水平显著高于TA组和NG组,经单因素方差分析,差异有统计学意义(F=4.120,4.636,6.638;P=0.016,0.01,0.001)。TSH在DTC组与良性甲状腺疾病的阳性率无差别,TPOAb在DTC组的阳性率为30.2%,而在TA组和NG组的阳性率分别为12.5%和13.7%,差异有统计学意义(χ^2=21.43,P<0.01)。DTC组的TGAb阳性率为26.9%,而TA和NG组的阳性率分别为15.5%和12.0%,差异有统计学意义(χ^2=11.91,P=0.002)。转移性DTC和未转移性DTC组的TSH,TPOAb和TGAb,经t检验统计分析,差异无统计学意义(t=1.976,1.974,1.973;P=0.572,0.574,0.577)。TPOAb和TGAb在鉴别DTC和TA的曲线下面积分别是0.612和0.610。TPOAb和TGAb在鉴别DTC和NG的曲线下面积分别是0.577和0.620。TGAb在最佳临界点诊断DTC的敏感度为73.7%,特异度为52.6%。结论TSH浓度和甲状腺自身抗体水平升高与DTC的发病有一定的相关关系,TGAb在甲状腺癌和甲状腺良性结节的鉴别诊断中具有一定价值。Objective To investigate the diagnostic value of thyroid stimulating hormone(TSH)and thyroid autoantibodies(TPOAb,TGAb)in benign and malignant thyroid nodules.Methods A retrospective investigation method was used to collect the pathological and clinical data of 500 cases of thyroid nodules treated with surgery and pathological confirmation from March 2013 to September 2018,including 152 cases of papillary thyroid carcinoma,232 cases of thyroid adenomas,and 116 cases of nodular goiter.Results The levels of TSH,TPOAb and TGAb in the thyroid cancer group were significantly higher than those of the thyroid adenomas group and the nodular goiter group(F=4.120,4.636 and 6.638;P=0.016,0.01,0.001).The positive rate of TSH in thyroid cancer and benign thyroid disease groups was not significantly different,but the positive rate of TPOAb and TGAb was significantly higher than that of two other groups.The positive rate of TPOAb in thyroid papillary carcinoma was 30.2%,and the positive rates of thyroid adenomas group and the thyroid nodular goiter group were 12.5%and 13.7%(χ^2=21.43,P<0.01)respectively.The positive rate of TGAb in papillary thyroid carcinoma was 26.9%,while the positive rate in thyroid adenomas and nodular goiter was 15.5%and 12.0%(χ^2=11.91,P=0.002)respectively.TSH,TPOAb and TGAb of metastatic DTC and non-DTC groups were statistically analyzed by t test,the difference was not statistically significant(t=1.976,1.974 and 1.973,P=0.572,0.546 and 0.577).The ROC curve analysis showed that the areas under the curve of the papillary carcinoma and thyroid adenomas were 0.612 and 0.610,respectively.To diagnose papillary carcinoma and nodular goiter,the areas under the curve of TPOAb and TGAb were 0.577 and 0.620,respectively.The sensitivity of TGAb to diagnose thyroid cancer at the optimal critical point was 73.7%,and the specificity was 52.6%.Conclusion The increase of TSH concentration and thyroid autoantibodies had a little correlation with the incidence of papillary thyroid cancer.TGAb has preliminary diagnostic

关 键 词：甲状腺结节 乳头状甲状腺癌 促甲状腺激素 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 

分 类 号：R736.1[医药卫生—肿瘤] R730.43[医药卫生—临床医学]