超声声脉冲辐射力成像-声触诊组织定量技术、丝氨酸/苏氨酸蛋白激酶基因检测与甲状腺弥漫性病变合并甲状腺癌中医证型的关系及诊断效能  

Relationship of ARFI-VTQ and BRAF gene detection with the traditional Chinese medicine syndromes of diffuse thyroid lesions combined with thyroid cancer

作　　者：高峰[1] 郑斌[1] 刘杰 马远新[3] 李卫[2] 黄梅[1] 迟秀娥[4] GAO Feng;ZHENG Bin;LIU Jie;MA Yuanxin;LI Wei;HUANG Mei;CHI Xiu'e(First Department of Ultrasound,Cangzhou Hospital of Integrated TCM-WMHEBEI,Cangzhou,Hebei 061001;Department of Head and Neck Thyroid Surgery,Cangzhou Hospital of Integrated TCM-WMHEBEI,Cangzhou,Hebei 061001;Department of Internal Medicine of Traditional Chinese Medicine,Cangzhou Hospital of Integrated TCM-WMHEBEI,Cangzhou,Hebei 061001;Department of Thyroid Diseases,Cangzhou Hospital of Integrated TCM-WMHEBEI,Cangzhou,Hebei 061001)

机构地区：[1]河北省沧州中西医结合医院超声医学一科,河北沧州061001 [2]河北省沧州中西医结合医院头颈甲状腺外科,河北沧州061001 [3]河北省沧州中西医结合医院中医内科,河北沧州061001 [4]河北省沧州中西医结合医院甲状腺内科,河北沧州061001

出　　处：《河北中医》2024年第12期1990-1995,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：河北省中医药管理局2024年度中医药类科学研究课题计划项目(编号:2024177)。

摘　　要：目的分析超声声脉冲辐射力成像-声触诊组织定量技术(ARFI-VTQ)、B-Raf原癌基因丝氨酸/苏氨酸蛋白激酶(BRAF)基因检测对甲状腺弥漫性病变合并甲状腺癌的诊断效能,以及与甲状腺癌中医证型的关系。方法选择2023年1月至2023年12月于河北省沧州中西医结合医院超声医学一科进行甲状腺弥漫性病变合并甲状腺结节检查的患者130例作为研究对象,根据病理检查结果分为良性组(n=88)和恶性组(n=42),所有患者均行超声ARFI-VTQ检查和BRAF基因检测,并进行中医辨证分型。比较良性组与恶性组、恶性组不同中医证型患者常规超声特征、SWV值以及BRAF基因检测阳性率;行受试者工作特征(ROC)曲线分析,分析超声ARFI-VTQ和BRAF基因检测对甲状腺弥漫性病变合并甲状腺癌的诊断效能。结果良性组与恶性组患者,以及恶性组气滞血瘀证、肝郁痰凝证、气阴两虚证患者常规超声特征的边界、形状、回声和内部血流比较差异均无统计学意义(P>0.05)。恶性组SWV值高于良性组(P<0.05);恶性组不同中医证型患者SWV值也存在明显差异,其中气滞血瘀证最高,气阴两虚证最低,比较差异有统计学意义(P<0.05)。良性组BRAF基因突变阳性率低于恶性组(P<0.05);恶性组不同中医证型患者BRAF基因突变阳性率比较差异无统计学意义(P>0.05)。ROC曲线分析结果显示,SWV值和BRAF基因检测结果对甲状腺弥漫性病变合并甲状腺癌的曲线下面积(AUC)分别为0.759和0.674,敏感度分别为88.10%和76.19%,特异性分别为90.17%和84.97%,约登指数分别为0.783和0.612。但是联合检测降低了检测的特异性,导致约登指数降低为0.369。结论超声ARFI-VTQ检查、BRAF基因检测对甲状腺弥漫性病变合并甲状腺癌的诊断具有重要的价值,其中ARFI-VTQ检查对甲状腺弥漫性病变合并甲状腺癌患者的辨证分型有重要的参考价值。Objective To analyze the role of ultrasound acoustic radiation force impulse imaging with virtual touch tissue quantification(ARFI-VTQ)and B-Raf proto-oncogene,serine/threonine kinase(BRAF)gene detection in the differential diagnosis of diffuse thyroid lesions with thyroid cancer,as well as the correlation with traditional Chinese medicine(TCM)syndromes of thyroid cancer.Methods A total of 130 patients with diffuse thyroid lesions and thyroid cancer examined in the First Department of Ultrasound,Cangzhou Hospital of Integrated TCM-WMHEBEI from January 2023 to December 2023 were included.According to the pathological examination results,the patients were divided into the benign group(n=88)and malignant group(n=42).All patients underwent ARFI-VTQ and BRAF gene testing,and classified according to TCM syndrome differentiation.Conventional ultrasound parameters,shear wave velocity(SWV),and positive rates in BRAF gene testing were compared between benign and malignant groups,and TCM syndrome type groups.The diagnostic efficacy of ARFI-VTQ and BRAF gene testing in diffuse thyroid lesions and thyroid cancer was analyzed by the receiver operating characteristic(ROC)curve.Results There were no significant differences in the boundary,shape,echo,and internal blood flow of conventional ultrasound features between the benign and malignant groups,as well as patients with different TCM syndrome types(Qi stagnation and blood stasis syndrome,liver stagnation and phlegm coagulation syndrome,Qi-Yin deficiency syndrome)in the malignant group(P>0.05).The ARFI-VTQ showed a significantly higher SWV in the malignant group than that of the benign group(P<0.05).There was also a significant difference in SWV among patients with different TCM syndrome types in the malignant group,with the highest in patients with Qi stagnation and blood stasis syndrome and the lowest in patients with Qi-Yin deficiency syndrome(P<0.05).The BRAF gene testing showed a significantly lower positive rate of gene mutations in the benign group than the malignant gro

关 键 词：甲状腺弥漫性病变 甲状腺肿瘤 声脉冲辐射力成像 声触诊组织定量技术 原癌基因蛋白质B-raf 辨证分型 

分 类 号：R581.9[医药卫生—内分泌] R736.1[医药卫生—内科学] R2-03[医药卫生—临床医学]