PTC患者发生LNM的危险因素分析  

Risk Factors of Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

作　　者：付吉鹤 李晓琴[1] 赵彤 壮健 朱韦文[1] 张超[1] Fu Jihe;Li Xiaoqin;Zhao Tong;Zhuang Jian;Zhu Weiwen;Zhang Chao(Department of Ultrasound,The Affiliated Changzhou Second People's Hospital With Nanjing Medical University,Changzhou,Jiangsu 213004,China;Graduate School of Dalian Medical University,Dalian,Liaoning 116000,China)

机构地区：[1]常州市第二人民医院超声科,江苏省常州市213004 [2]大连医科大学研究生院,辽宁省大连市116000

出　　处：《中国超声医学杂志》2023年第2期129-133,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 探究甲状腺乳头状癌(PTC)患者发生淋巴结转移(LNM)的危险因素及风险预测价值。方法 回顾性纳入PTC患者436例作为研究对象,根据患者是否发生LNM分为转移组(203例)和未转移组(233例)。收集行手术治疗PTC患者90例作为外部验证组。行多普勒超声甲状腺超声检查,化学发光免疫分析仪检测甲状腺相关指标。多因素Logistic回归分析PTC患者发生LNM危险因素;依据危险因素做列线图并分析对验证组的诊断价值。结果 Logistic回归模型分析结果显示肿瘤形态、纵横比A/T、钙化、相对被膜位置、游离三碘甲状腺素、促甲状腺激素和甲状腺球蛋白抗体是PTC患者发生LNM的危险因素(P<0.05);基于危险因素建立PTC患者发生LNM风险预测列线图得分为300分,预测概率为0.916;Bootstrap重复抽样方法行内部验证,列线图模型校正后的C指数为0.827,在Bootstrap样本中仍具有良好的区分度和预测能力。结论 基于临床特征、超声和实验室指标建立PTC患者发生LNM风险预测列线图,列线图具有良好的区分度和预测能力,可以为PTC患者发生LNM提供预测。Objective To explore the risk factors and risk predictive value of lymph node metastasis(LNM) in patients with papillary thyroid carcinoma(PTC). Methods A total of 436 patients with PTC in our hospital were retrospectively included in the study. According to the presence of LNM, they were divided into the metastasis group(n=203) and the non-metastasis group(n=233). A total of 90 patients with PTC who were underwent surgical treatment in our hospital were included in the external validation group. Thyroid ultrasonography was performed by Doppler ultrasound, and thyroid related indicators were detected by chemiluminescence immunoanalyzer. Uni-and Multivariate Logistic regression analysis were used to analyze the risk factors of LNM in PTC patients. Nomogram was made according to risk factors and the diagnostic value in the validation group was analyzed. Results Logistic regression model analysis showed that tumor morphology, aspect ratio A/T, calcification, relative capsule position, free triiodothyroxine, thyroid stimulating hormone and thyroglobulin antibody were independent risk factors for LNM in PTC patients(P<0.05). The nomogram score of LNM risk prediction in PTC patients based on risk factors was 300, and the prediction probability was 0.916. The Bootstrap repeated sampling method was verified internally, and the C-index of the nomogram model after correction was 0.827, which still had good discrimination and prediction ability in the Bootstrap samples. Conclusions Based on the clinical characteristics, ultrasound and laboratory indicators, the nomogram of LNM risk prediction for PTC patients is established. The nomogram has good discrimination and prediction ability, and can provide prediction for PTC patients.

关 键 词：超声 甲状腺 实验室 列线图 PTC LNM 预测价值 

分 类 号：R736.1[医药卫生—肿瘤]