血清Tg、TSH检测对甲状腺癌术前N分期的诊断价值  

Diagnostic value of serum Tg and TSH in preoperative N staging of thyroid carcinoma

作　　者：岳鑫 罗征[1] 朱晓月 YUE Xin;LUO Zheng;ZHU Xiao-yue(Department of Ear-nose-throat,Tianjin Occupational Disease Prevention Hospital,Tianjin 300011,China)

机构地区：[1]天津市职业病防治院耳鼻喉科,天津300011

出　　处：《中国实验诊断学》2023年第5期529-532,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨血清甲状腺球蛋白(Tg)、促甲状腺激素(TSH)对甲状腺癌术前N分期的诊断价值。方法回顾性分析106例经手术病理证实的甲状腺癌患者临床资料,根据术后病理N分期,将患者分为pN1、pN1a和pN1b期;比较不同分期Tg、TSH等血清标志物水平,用Logistic回归模型分析N分期的影响因素,并构建Tg、TSH诊断甲状腺癌术前N分期的受试者工作特征(ROC)曲线。结果相比pN0期组,pN1期组血清Tg、TSH水平均显著增高(P<0.05),两组三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(fT3)、甲状腺素(TT4)、游离甲状腺素(fT4)、抗甲状腺球蛋白抗体(TGAb)水平对比差异无统计学意义(P>0.05)。Logistic回归分析显示,血清Tg、TSH水平是术前N分期的独立影响因素(P<0.05)。ROC曲线分析显示,血清Tg、TSH诊断甲状腺癌淋巴结转移(pN1期)的AUC分别为0.811(95%CI:0.723~0.880)、0.902(95%CI:0.828~0.951),二者差异无统计学意义(P>0.05);二者联合的AUC为0.944(95%CI:0.881~0.979),优于单一Tg、TSH,差异有统计学意义(P<0.05)。结论血清Tg、TSH均可作为甲状腺癌术前N分期的诊断标志物,且二者联合检测可提高诊断效能。Objective To investigate the diagnostic value of serum thyroglobulin(Tg)and thyroid stimulating hormone(TSH)in preoperative N staging of thyroid cancer.Methods The clinical data of 106 patients with thyroid cancer confirmed by surgery and pathology were retrospectively analyzed.According to the postoperative pathological N stage,the patients were divided into pNl,pN1a and pN1b stages.The levels of serum markers such as Tg and TSH in different stages were compared.The influencing factors of N stage were analyzed by Logistic regression model,and the receiver operating characteristic(ROC)curve of Tg and TSH in the diagnosis of preoperative N stage of thyroid cancer was constructed.Results Compared with pNO group,the levels of serum Tg and TSH in pN1 group were significantly increased(P<0.05).There was no significant difference in the levels of triodothyronine(TT3),free triodothyronine(fT3),thyroxine(TT4),free thyroxine(fT4)and thyroglobulin antibody(TGAb)between the two groups(P>0.05).Logistic regression analysis showed that serum Tg and TSH levels were independent influencing factors of preoperative N stage(P<0.05).ROC curve analysis showed that the AUCs of serum Tg and TSH in the diagnosis of lymph node metastasis of thyroid cancer(pN1 phase)were 0.811(95%CI:0.723~0.880)and 0.902(95%CI:0.828~0.951),respectively,and the difference was not statistically significant(P>0.05).The AUC of the combination of the two was 0.944(95%CI:0.881~0.979),which was better than that of single Tg and TSH,and the difference was statistically significant(P<0.05).Conclusion Serum Tg and TSH can be used as diagnostic markers for preoperative N staging of thyroid cancer,and the combined detection of the two can improve the diagnostic efficacy.

关 键 词：甲状腺癌 临床分期 淋巴结转移 甲状腺球蛋白 促甲状腺激素 

分 类 号：R736.1[医药卫生—肿瘤]