彩超联合血清血清抗甲状腺球蛋白抗体、抗甲状腺过氧化物酶抗体、B型RAF基因V600E在诊断多灶性甲状腺乳头状癌的应用价值  

Value of color Doppler ultrasound combined with serum anti-thyroglobulin antibody,anti-thyroid peroxidase antibody and BRAF gene V600E mutation in diagnosing multifocal papillary thyroid carcinoma

作　　者：廖观生 王晓龙[2] 徐波[1] 吴立旋[2] Liao Guansheng;Wang Xiaolong;Xu Bo;Wu Lixuan(Department of Thyroid Surgery,Guangzhou First People’s Hospital,Guangzhou 510180,Guangdong,China;Department of Thyroid Surgery,Huizhou Central People’s Hospital,Guangzhou 510180,Guangdong,China)

机构地区：[1]广州医科大学附属广州市第一人民医院甲状腺外科 [2]惠州市中心人民医院甲状腺外科,广东广州510180

出　　处：《广州医科大学学报》2020年第5期53-57,共5页Academic Journal of Guangzhou Medical University

摘　　要：目的:探讨彩超联合血清抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)、B型RAF基因V600E(BRAFV600E)在诊断多灶性甲状腺乳头状癌(MPTC)的应用价值。方法:2016年6月至2019年6月惠州市中心人民医院收治的甲状腺癌805例中106例MPTC为A组,4例甲状腺髓样癌(MTC)患者为B组,剩余695例甲状腺乳头状癌(PTC)为C组。比较三组血清TGAb、TPOAb阳性率以及BRAFV600E基因突变状况。以活检结果为金标准,诊断试验四格表分析单独应用彩超检查、血清TGAb、TPOAb阳性以及BRAFV600E基因突变在MPTC诊断中的应用价值以及四者联合诊断MPTC的价值。结果:A组血清TGAb、TPOAb阳性率以及BRAFV600E基因突变率均高于B组和C组(P<0.05)。多因素Logisitic分析结果显示,血清TGAb阳性、TPOAb阳性、BRAFV600E基因突变等均是MPTC的高危因素。彩超检查诊断MPTC的敏感度、特异度、准确性、漏诊率和误诊率分别为80.19%、74.39%、75.16%、19.81%和25.61%;血清TGAb阳性诊断MPTC的敏感度、特异度、准确性、漏诊率和误诊率分别为80.19%、75.54%、76.15%、19.81%和24.46%;血清TPOAb阳性诊断MPTC的敏感度、特异度、准确性、漏诊率和误诊率分别为76.42%、76.39%、76.40%、23.58%和23.61%;BRAFV600E基因突变诊断MPTC的敏感度、特异度、准确性、漏诊率和误诊率分别为78.30%、69.10%、70.31%、21.70%和30.90%。超联合血清TGAb、TPOAb阳性以及BRAFV600E基因突变联合诊断MPTC的敏感度、特异度、准确性、漏诊率和误诊率分别为95.28%、97.42%、97.14%、4.72%和2.58%。相对于单独应用于MPTC诊断,彩超联合血清TGAb、TPOAb阳性以及BRAFV600E基因突变联合诊断MPTC的敏感度、特异度和准确性均提高,漏诊率和误诊率则均降低(P<0.05)。结论:彩超联合血清TGAb、TPOAb阳性以及BRAFV600E基因突变联合诊断MPTC的敏感度、特异度和准确性均较高,可有效减少漏诊误诊,在MPTC诊断和鉴别诊断中的应用�Objective:To determine the value of color Doppler ultrasound combined with serum anti-thyroglobulin antibody(TGAb),anti-thyroid peroxidase antibody(TPOAb)and BRAF gene V600E(BRAF-V600E)mutation in identifying multifocal papillary thyroid carcinoma(MPTC).Methods:Included in this study were 805 patients with thyroid carcinoma admitted to Huizhou Central People’s Hospital between June 2016 and June 2019,comprising 106 patients with MPTC in Group A,four with medullary thyroid carcinoma(MTC)in Group B,and the remaining 695 with papillary thyroid carcinoma(PTC)in Group C.The positive rates of serum TGAb and TPOAb,and BRAFV600E mutation were compared among the three groups.By using the biopsy findings as the gold standard,a fourfold table was used to evaluate the diagnostic performance of of color Doppler ultrasound,serum TGAb or TPOAb positivity and BRAF-V600E mutation,alone or combined,in identifying MPTC.Results:The positive rates of serum TGAb,TPOAb and BRAF-V600E mutation in group A were higher than those in groups B and C(P<0.05).Multivariate logistic analysis showed that serum TGAb or TPOAb positivity and BRAF-V600E mutation were high risk factors for MPTC.The sensitivity,specificity,accuracy,and rates of missed diagnosis and misdiagnosis in identifying MPTC were 80.19%,74.39%,75.16%,19.81%and 25.61%by color Doppler ultrasound;80.19%,75.54%,76.15%,19.81%and 24.46%by serum TGAb positivity;76.42%,76.39%,76.40%,23.58%and 23.61%by serum TPOAb positivity;78.30%,69.10%,70.31%,21.70%and 30.90%by BRAF-V600E mutation.The sensitivity,specificity,accuracy,rates of missed diagnosis and misdiagnosis in identifying MPTC by combined use of color Doppler ultrasound,serum TGAb or TPOAb positivity and BRAF-V600E mutation were 95.28%,97.42%,97.14%,4.72%and 2.58%,respectively.Compared with any method alone,color Doppler ultrasound combined with serum TGAb or TPOAb positivity and BRAF-V600E mutation yielded higher sensitivity,specificity and accuracy but lower rates of missed diagnosis and misdiagnosis in identifying MPTC(P<0.05).C

关 键 词：彩超 抗甲状腺球蛋白抗体 抗甲状腺过氧化物酶抗体 B型RAF基因V600E 诊断 多灶性甲状腺乳头状癌 

分 类 号：R581[医药卫生—内分泌]