实时剪切波弹性成像弹性指数联合血清SIL-2R、MMP-2水平对甲状腺微小乳头状癌颈部淋巴结转移的预测价值  

Predictive value of real-time shear wave elastography elasticity index combined with serum SIL-2R and MMP-2 levels in cervical lymph node metastasis of thyroid micropapillary carcinoma

作　　者：陈虹 戚凯 何柳 雷建卫 李康 Chen Hong;Qi Kai;He Liu;Lei Jianwei;Li Kang(Department of Ultrasound Medicine,Baoji Central Hospital,Shaanxi Province,Baoji 721008,China)

机构地区：[1]陕西省宝鸡市中心医院超声医学科,721008 [2]陕西省宝鸡市中心医院检验科,721008 [3]陕西省宝鸡市中心医院肿瘤外科,721008 [4]陕西省宝鸡市中心医院肿瘤内科,721008

出　　处：《疑难病杂志》2024年第6期658-662,674,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省科技计划项目(2019M041)。

摘　　要：目的探讨实时剪切波弹性成像(SWE)弹性指数联合血清可溶性白介素-2受体(sIL-2R)、基质金属蛋白酶-2(MMP-2)水平对甲状腺微小乳头状癌(PTMC)发生颈部淋巴结转移的预测价值。方法选择2020年1月—2023年1月宝鸡市中心医院肿瘤外科收治的PTMC患者98例为PTMC组,根据术后病理提示颈部淋巴结转移情况将患者分为转移亚组(32例)和未转移亚组(66例),另选择良性甲状腺结节患者52例为对照组。所有患者术前均应用SWE检查最大值(Emax)、最小值(Emin)和平均值(Emean);检测血清sIL-2R和MMP-2水平;多因素Logistic回归分析PTMC患者颈部淋巴结转移的影响因素;受试者工作特征(ROC)曲线分析SWE参数和sIL-2R、MMP-2预测PTMC患者颈部淋巴结转移的价值。结果转移亚组年龄低于未转移亚组,多发病灶比例、包膜侵犯比例、肿瘤直径大于未转移亚组(t/χ^(2)/P=8.867/<0.001、6.329/0.012、5.669/0.017、10.080/<0.001);转移亚组Emax、Emin、Emean高于未转移亚组和对照组(F/P=100.582/<0.001、289.716/<0.001、183.654/<0.001),但未转移亚组与对照组比较差异无统计学意义(P>0.05);转移亚组血清sIL-2R、MMP-2水平高于未转移亚组高于对照组(F/P=367.973/<0.001、414.371/<0.001);包膜侵犯、较大肿瘤直径、高Emax、高sIL-2R、高MMP-2是PTMC患者颈部淋巴结转移的危险因素[OR(95%CI)=3.459(1.534~7.802)、2.321(1.144~4.709)、1.902(1.088~3.325)、1.702(1.066~2.719)、1.748(1.078~2.838)];Emax、sIL-2R、MMP-2及三者联合预测PTMC淋巴结转移的曲线下面积分别为0.852、0.794、0.795、0.931,三者联合的AUC大于单独预测(Z=1.953、2.940、2.674,P=0.023、<0.001、0.005)。结论PTMC患者SWE参数Emax值和血清sIL-2R、MMP-2水平增高与颈部淋巴结转移有关,联合Emax和sIL-2R、MMP-2可预测PTMC颈部淋巴结转移风险。Objective To investigate the predictive value of real-time shear wave elastography(SWE)elasticity index combined with serum levels of soluble interleukin-2 receptor(sIL-2R)and matrix metalloproteinase-2(MMP-2)in cervical lymph node metastasis of thyroid micropapillary carcinoma(PTMC).Methods Ninety-eight patients with PTMC admitted to the Department of Ultrasound Medicine,Baoji Central Hospital from January 2020 to January 2023 were selected.All patients underwent SWE examination before surgery to detect serum sIL-2R and MMP-2 levels.The patients were divided into a metastatic group(32 cases)and a non-metastatic group(66 cases),and 52 benign thyroid nodule patients were selected as the control group.Multivariate Logistic regression analysis of the factors of cervical lymph node metastasis in PTMC patients.The value of receiver operating characteristic(ROC)curve analysis of SWE parameters and sIL-2R and MMP-2 in predicting cervical lymph node metastasis in PTMC patients.Results The age of metastatic subgroup was lower than that of non-metastatic subgroup,the proportion of multiple lesions,the proportion of envelope invasion,and the tumor diameter were higher than that of non-metastatic subgroup(t/χ^(2)/P=8.867/<0.001,6.329/0.012,5.669/0.017,10.080/<0.001).Emax,Emin and Emean in metastasis subgroups were higher than non-metastasis subgroups and control groups(F/P=100.582/<0.001,289.716/<0.001,183.654/<0.001),but there was no significant difference between non-metastasis subgroups and control group(P>0.05).Serum sIL-2R and MMP-2 levels in metastatic subgroup were higher than those in non-metastasis subgroup and control group(F/P=367.973/<0.001,414.371/<0.001).Capsular invasion,large tumor diameter,high Emax,high sIL-2R,and high MMP-2 were risk factors for cervical lymph node metastasis in PTMC patients[OR(95%CI)=3.459(1.534-7.802),2.321(1.144-4.709),1.902(1.088-3.325),1.702(1.066-2.719),1.748(1.078-2.838)].The area under the curve of Emax,sIL-2R,MMP-2 and the combined prediction of PTMC lymph node metastasis were 0

关 键 词：甲状腺微小乳头状癌 颈部淋巴结转移 实时剪切波弹性成像 可溶性白介素-2受体 基质金属蛋白酶-2 

分 类 号：R736.1[医药卫生—肿瘤]