外周血双阴性T细胞、自然杀伤性T细胞及血清刺激性甲状腺球蛋白含量在预测分化型甲状腺癌术后^(131)I疗效中价值研究  

The value of combined detection of peripheral blood double negative T cells,natural killer T cells and serum pre-treatment stimulative Tg in predicting the response to ^(131)I treatment in differentiated thyroid carcinoma

作　　者：吴艳花 郭佳琪 丁春梅 包慧 陈英剑 刘晓斐 WU Yan-hua;GUO Jia-qi;DING Chun-mei;BAO Hui;CHEN Ying-jian;LIU Xiao-fei(Department of Laboratory Medicine,No.960 Hospital of the PLA Joint Logistics Support Force,Jinan 250031,China;School of Medical Laboratory,ShanDong Second Medical University,Weifang 261053,China)

机构地区：[1]联勤保障部队第九六〇医院检验科,山东济南250031 [2]山东第二医科大学医学检验学院,山东潍坊261053

出　　处：《临床军医杂志》2024年第9期896-901,共6页Clinical Journal of Medical Officers

基　　金：山东省自然科学基金面上项目(ZR2021MC137)。

摘　　要：目的探讨外周血双阴性T细胞(DNT)、自然杀伤性T细胞(NKT)及治疗前刺激性甲状腺球蛋白(ps-Tg)在预测分化型甲状腺癌(DTC)术后^(131)I治疗反应中的价值。方法选取2018年1—12月就诊于联勤保障部队960医院核医学科行^(131)I治疗的215例DTC术后患者为研究对象。根据2015版美国甲状腺学会指南将患者分为疗效满意(ER)组(n=121)、疗效不确切(IDR)组(n=59)、疗效不佳(IR)组(n=35);根据1年内复发情况将患者分为复发组(n=17)与无复发组(n=198)。比较不同疗效组间在性别、年龄、淋巴结转移、TNM分期等特征方面的差异。比较不同疗效组及不同临床转归组在DTC术后外周血DNT百分比、NKT百分比及ps-Tg水平表达的差异。采用Mann-Whitney U秩和检验分析DNT、NKT及ps-Tg水平与^(131)I治疗后临床转归ER组的关系,并采用受试者工作特征(ROC)曲线及最佳界值点评估各指标单独及联合检测对最佳治疗反应的预测价值。结果ER组、IDR组、IR组患者在性别、年龄方面比较,差异均无统计学意义(P>0.05);在淋巴结分期、TNM分期方面比较,差异均有统计学意义(P<0.05)。IDR组和IR组的DNT百分比、NKT百分比高于ER组,IR组ps-Tg高于IDR组、ER组,差异均有统计学意义(P<0.05)。复发组的DNT百分比、ps-Tg水平均高于非复发组,差异均有统计学意义(P<0.05);两组NKT百分比比较,差异无统计学意义(P>0.05)。DNT和ps-Tg对最佳治疗反应ER的预测价值较高[曲线下面积(AUC)分别为0.748、0.776],界值点分别为7.15%、8.44 ng/ml;且两种检测指标的灵敏度、特异性比较,差异均无统计学意义(P>0.05)。3种检测指标联合时预测价值最高(AUC=0.844,灵敏度93.6%,特异性66.6%)。结论中高危DTC患者术后^(131)I治疗前DNT百分比、NKT百分比可以预测临床转归,DNT和NKT升高可提示不良预后及高复发风险;DNT和ps-Tg单独检测预测最佳治疗反应的效能相当,DNT、NKT及ps-Tg三者联合检测可对Objective To investigate the value of peripheral blood double-negative T cells(DNT),natural killer T cells(NKT)and pre-treatment stimulative Tg(ps-Tg)in predicting ^(131)I response after surgery for differentiated thyroid cancer(DTC).Methods A total of 215 postoperative DTC patients who received ^(131)I treatment in the Department of Laboratory Medicine of No.960th Hospital of the PLA Joint Logistics Support Force from January to December 2018 were selected as the study objects.According to the 2015 American Thyroid Society guidelines,the patients were divided into excellent response(ER)group(n=121),indeterminate response(IDR)group(n=59)and incomplete respmse(IR)group(n=35).Patients were divided into recurrence group(n=17)and no recurrence group(n=198)according to the recurrence situation within 1 year.The differences in gender,age,lymph node metastasis and TNM stage among different therapeutic groups were compared.The difference of DNT percentage,NKT percentage and ps-Tg level in peripheral blood after DTC was compared between different therapeutic effect groups and different clinical outcome groups.Mann-Whitney U rank sum test was used to analyze the relationship between DNT,NKT and ps-Tg levels and clinical outcomes in the ER group after ^(131)I treatment,and receiver operating characteristic(ROC)curve and optimal cut-off point were used to evaluate the predictive value of each indicator alone and combined detection for optimal treatment response.Results There was no significant difference in gender and age between ER group,IDR group and IR group(P>0.05).There were significant differences in lymph node stage and TNM stage(P<0.05).DNT percentage and NKT percentage in IDR and IR groups were higher than those in ER group,and ps-Tg in IR group was higher than those in IDR and ER group,with statistical significance(P<0.05).DNT percentage and ps-Tg level in relapsing group were higher than those in non-relapsing group,with statistical significance(P<0.05).There was no significant difference in NKT percentage between

关 键 词：分化型甲状腺癌 ^(131)I治疗 双阴性T细胞 自然杀伤性T细胞 治疗前刺激性甲状腺球蛋白 

分 类 号：R736.1[医药卫生—肿瘤]