剪切波弹性成像参数联合血清中期因子、胸苷激酶1、促甲状腺素与甲状腺球蛋白比值鉴别诊断甲状腺结节的临床价值  

Clinical value of shear wave elastography combined with serum midkine,thymidine kinase 1,ratio of thyrotropin and thyroglobulin in the differential diagnosis of thyroid nodules

作　　者：柯淑丽 胡兵[1] 车鹏飞 王凡[1] 向小蔚 胡莉莉 KE Shuli;HU Bing;CHE Pengfei;WANG Fan;XIANG Xiaowei;HU Lili(Department of Ultrasound,Renhe Hospital Affiliated to Three Gorges University,Hubei 443001,China)

机构地区：[1]三峡大学附属仁和医院超声科,湖北省宜昌市443001

出　　处：《临床超声医学杂志》2023年第8期654-658,共5页Journal of Clinical Ultrasound in Medicine

基　　金：湖北省卫生健康委2019年度第三批联合基金立项项目(WJ2019H541)。

摘　　要：目的 探讨剪切波弹性成像(SWE)参数联合血清中期因子(MK)、胸苷激酶1(TK1)、促甲状腺素与甲状腺球蛋白比值(TSH/Tg)鉴别诊断甲状腺结节良恶性的临床价值。方法 选取我院经术后病理结果或穿刺结果证实的甲状腺结节患者129例,均为单发病灶,其中良性组98例,恶性组31例,均行SWE检查及血清MK、TK1、TSH、Tg检测,比较两组SWE参数[杨氏模量最小值(Emin)、最大值(Emax)、平均值(Emean)],以及血清MK、TK1、TSH/Tg的差异。应用Logistic回归分析建立SWE参数联合血清MK、TK1、TSH/Tg的诊断模型;绘制受试者工作特征(ROC)曲线分析该模型鉴别甲状腺结节良恶性的诊断效能。结果 与良性组比较,恶性组Emax、Emin、Emean及血清MK、TK1、TSH/Tg均升高,差异均有统计学意义(均P<0.05)。应用Logistic回归分析建立SWE参数联合血清MK、TK1、TSH/Tg的诊断模型为:Logit(P)=-0.069+0.101×Emean+0.353×血清MK+0.328×血清TK1+0.882×血清TSH/Tg;ROC曲线分析显示,该模型鉴别诊断甲状腺结节良恶性的曲线下面积(AUC)、灵敏度、特异度分别为0.864、83.87%、85.71%,其鉴别诊断甲状腺结节良恶性的AUC高于各指标单独使用(0.756、0.719、0.709、0.732),差异均有统计学意义(均P<0.05)。结论 SWE参数联合血清MK、TK1、TSH/Tg在鉴别诊断甲状腺结节良恶性中有一定的临床价值。Objective To investigate the clinical value of shear wave elastography(SWE)combined with serum midkine(MK),thymidine kinase 1(TK1),ratio of thyrotropin and thyroglobulin(TSH/Tg)in the differential diagnosis of benign and malignant thyroid nodules.MethodsA total of 129 patients with thyroid nodules confirmed by postoperative pathological or puncture results in our hospital were selected,all of whom were single lesions.Among them,98 cases were in the benign group and 31 cases in the malignant group,all of whom underwent SWE examination and serum MK,TK1,TSH and Tg detection.SWE parameters[minimum Young's modulus(Emin),maximum Young's modulus(Emax)and average Young's modulus(Emean)],and the serum MK,TK1 and TSH/Tg were compared between the two groups.Logistic regression analysis was used to establish a diagnostic model of SWE parameter and serum MK,TK1,TSH/Tg.Receiver operating characteristic(ROC)curve was drawn to analyze the differential diagnosis value of the model for benign and malignant thyroid nodules.ResultsThe Emax,Emin,Emean and the serum MK,TK1,TSH/Tg in the malignant group were significantly increased compared with the benign group,the difference were statistically significan(tall P<0.05).Diagnosis model of SWE parameters combined with serum MK,TK1,TSH/Tg established by Logistics regression analysis was:Logi(tP)=-0.069+0.101×Emean+0.353×MK+0.328×TK1+0.882×TSH/Tg.ROC curve analysis showed that the area under curve(AUC),sensitivity and specificity of the model in the differential diagnosis of benign and malignant thyroid nodules were 0.864,83.87% and 85.71%,and the AUC was significantly higher than the above indicators used alone(0.756,0.719,0.709,0.732),with statistical significance(all P<0.05).Conclusion The combination of SWE parameter and serum MK,TK1,TSH/Tg has certain clinical value in the differential diagnosis of benign and malignant thyroid nodules.

关 键 词：剪切波弹性成像 甲状腺结节 良恶性 血清中期因子 血清胸苷激酶1 促甲状腺素与甲状腺球蛋白比值 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]