多普勒超声联合Cyfra21-1、sIL-2R对甲状腺微小乳头状癌颈侧区淋巴结转移的预测价值  

Prognostic value of Doppler ultrasound combined with Cyfra21-1 and sIL-2R in cervical lymph node metastasis of thyroid micropapillary carcinoma

作　　者：唐瑾 苗润琴[1] 杨立[1] 秦彦超 王兆捷 张波[1] Tang Jin;Miao Runqin;Yang Li;Qin Yanchao;Wang Zhaojie;Zhang Bo(Ultrasound Department,Shanxi Provincial Cancer Hospital,Shanxi Hospital,Cancer Hospital of Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030001,China;Head and Neck Surgery Ward,Shanxi Provincial Cancer Hospital(Shanxi Hospital of Cancer Hospital of Chinese Academy of Medical Sciences),Cancer Hospital of Shanxi Medical University,Taiyuan 030001,China;Laboratory Department Shanxi Provincial Cancer Hospital(Chinese Academy of Medical Sciences Cancer Hospital Shanxi Hospital/Shanxi Medical University Affiliated Cancer Hospital),Taiyuan 030001,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院超声科,太原市030001 [2]山西省肿瘤医院,中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院头颈外科病区,太原市030001 [3]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院,山西医科大学附属肿瘤医院检验科,太原市030001

出　　处：《中华内分泌外科杂志（中英文）》2024年第5期691-695,共5页Chinese Journal of Endocrine Surgery

基　　金：山西省科研专项课题(DJKZXKT2023278)。

摘　　要：目的探讨分析多普勒超声联合细胞角蛋白片段19(cvtokeratin 19 fragments,Cyfra21-1)、可溶性白细胞介素-2受体(soluble interleukin-2 receptor,sIL-2R)对甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)颈侧区淋巴结转移(lateral lymph node metastasis,LLNM)的预测价值。方法选取山西省肿瘤医院超声科2020年8月至2023年8月收治的经手术病理证实的102例PTMC患者,均予以甲状腺切除术+中央区及至少一侧颈区淋巴结清扫,根据是否有LLNM分组,分为LLNM组(24例)和无LLNM组(78例)。结果两组年龄、形状、结节与被膜接触面积、瘤体形状纵横比>1、血流、微钙化、血清Cyfra21-1、血清sIL-2R水平比较,差异均具有统计学意义(Cyfra21-1:P<0.001,sIL-2R:P=0.001)。Logistic回归分析显示,年龄≥50岁(OR=0.443,95%CI:0.217~0.904)、微钙化(OR=2.787,95%CI:1.491~5.208)、Cyfra21-1>3.3 ng/mL(OR=3.117,95%CI:1.404~6.922)、sIL-2R>110.45 pmol/L(OR=3.408,95%CI:1.473~7.884)是PTMC患者LLNM的独立危险因素(P<0.05)。ROC曲线结果显示,多普勒超声联合Cyfra21-1、sIL-2R预测PTMC LLNM的曲线下面积为0.82,此时灵敏度和特异度分别为83.67%、70.56%。结论多普勒超声中钙化特征和血清Cyfra21-1、sIL-2R升高与PTMC LLNM密切相关,多普勒超声联合血清Cyfra21-1、sIL-2R对预测LLNM具有参考价值。ObjectiveTo investigate the predictive value of Doppler ultrasonography combined with cytokeratin fragment 19(Cyfra21-1)and soluble interleukin-2 receptor(sIL-2R)in cervical lymph node metastasis of thyroid micropapillary carcinoma.Methods102 patients with minimal papillary carcinoma of thyroid confirmed by surgery and pathology admitted to Ultrasound Department,Shanxi Cancer Hospital from Aug.2020 to Aug.2023 were selected and treated with thyroidectomy plus central region and at least one cervical lymph node dissection.Among them,There were 24 cases in the LLNM group and 78 cases in the non-LLNM group.ResultsThere were significant differences in age,shape,nodular and capsule contact area,tumor shape aspect ratio>1,blood flow,microcalcification,serum Cyfra21-1 and serum sIL-2R levels between the two groups(Cyfra21-1:P<0.001,sIL-2R:P=0.001).Logistic regression analysis showed that age≥50 years old(OR=0.443,95%CI:0.217-0.904),microcalcification(OR=2.787,95%CI:1.491-5.208),Cyfra21-1>3.3ng/ml(OR=3.117,95%CI:1.404-6.922)and sIL-2R>110.45pmol/L(OR=3.408,95%CI:1.473-7.884)were independent risk factors for cervical lymph node metastasis in PTMC patients(P<0.05).The ROC curve results showed that the area under the curve of cervical lymph node metastasis predicted by Doppler ultrasound combined with Cyfra21-1 and sIL-2R was 0.82,and the sensitivity and specificity were 83.67%and 70.56%,respectively.ConclusionsThe calcification features of Doppler ultrasound and the elevation of serum Cyfra21-1 and sIL-2R are closely related to cervical lymph node metastasis of thyroid micropapillary carcinoma.The combination of Doppler ultrasound with serum Cyfra21-1 and sIL-2R has important reference value in predicting cervical lymph node metastasis.

关 键 词：甲状腺癌 甲状腺微小乳头状癌 颈侧区淋巴结转移 多普勒超声 细胞角蛋白片段19 可溶性白细胞介素-2受体 

分 类 号：R736.1[医药卫生—肿瘤]