^(99)Tc^(m)O_(4)^(-)甲状腺显像诊断残甲的影响因素及24h摄碘率预测其阳性的分析  

An Analysis of Influencing Factors of ^(99)Tc^(m)O_(4)^(-)Thyroid Scan in the Diagnosisof Remnant Thyroid Tissue and 24h Thyroid RadioactiveIodine Uptake on Its Positive Prediction

作　　者：蔡小威 王波[1] 佘宇 刘宇杰 杨冬[2] CAI Xiaowei;WANG Bo;SHE Yu;LIU Yujie;YANG Dong(Department of Nuclear Medicine,the Affiliated Suqian First People’sHospital of Nanjing Medical University,Suqian 223800,China;Department of Radiology,the Affiliated Suqian First People’sHospital of Nanjing Medical University,Suqian 223800,China)

机构地区：[1]南京医科大学附属宿迁市第一人民医院核医学科,江苏宿迁223800 [2]南京医科大学附属宿迁市第一人民医院影像科,江苏宿迁223800

出　　处：《标记免疫分析与临床》2024年第11期1971-1975,共5页Labeled Immunoassays and Clinical Medicine

基　　金：宿迁市科技专项资助(新型临床诊疗技术及公共卫生)(编号:SY202204)。

摘　　要：目的分析^(99)Tc^(m)O_(4)^(-)甲状腺显像诊断残甲的影响因素及甲状腺24h摄碘率预测其阳性的价值。方法回顾性分析2020年1月至2022年12月间在宿迁市第一人民医院核医学科行首次131 I治疗的164例DTC患者(男52例,女112例;年龄23~76岁)的临床资料。患者分为131 I治疗前^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性组(114例)和阴性组(50例)。以口服治疗剂量131 I 72h后的131 I-SPECT/CT断层融合显像作为“金标准”,分析^(99)Tc^(m)O_(4)^(-)甲状腺显像灵敏度、特异性、准确度、阳性预测值、阴性预测值。对可能影响^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲的因素采用单因素分析。建立甲状腺24h摄碘率值预测^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的受试者工作特征(ROC)曲线。结果^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲灵敏度为70.44%(112/159),特异性为60.00%(3/5),准确度为70.12%(115/164),阳性预测值为98.24%(112/114),阴性预测值为3.75%(3/50)。两组间患者的性别及血清TSH水平是影响^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的因素(χ2=10.416,Z=2.78,均P<0.05),而两组间年龄、血清sTg及sTgAb水平差异无统计学意义(Z值:0.738、1.470和0.909,均P>0.05)。此外,^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性组24h摄碘率明显高于阴性组,差异有统计学意义(Z=7.607,P<0.05),24h摄碘率预测^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的ROC曲线下面积为0.873,最佳阈值为1.05%,95%CI为0.818~0.928,其预测^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的灵敏度、特异性分别为74.6%、90.0%。结论^(99)Tc^(m)O_(4)^(-)甲状腺显像评估分化型甲状腺癌术后残甲临床应用价值较高;患者的性别、血清TSH水平是影响^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的独立影响因素;24h摄碘率高于1.05%时,其预示^(99)Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的概率较高。Objective To analyze influence factors of ^(99)Tc^(m)O_(4)^(-)thyroid scan in the diagnosis of remnant thyroid tissue and the value of 24h thyroid iodine uptake(RAIU)in its positive prediction.Methods A retrospective analysis was performed on 164 DTC patients(52 males and 112 females,23-76 years old)who received 131 I treatment for the first time in the Department of Nuclear Medicine of the First People’s Hospital of Suqian City from January,2020 to December,2022.These patients were divided into a 131 I pre-treatment ^(99)Tc^(m)O_(4)^(-)thyroid imaging positive group(114 cases)and a negative group(50 cases).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ^(99)Tc^(m)O_(4)^(-)thyroid imaging were calculated using 131 I-SPECT/CT fusion imaging 72 hours after the oral therapeutic dose of 131 I as the“gold standard”.Factors that could affect ^(99)Tc^(m)O_(4)^(-)thyroid imaging were identified by single factor analysis.The receiver operating characteristic curve(ROC)of 24h RAIU was drawn to evaluate the positive prediction performance of ^(99)Tc^(m)O_(4)^(-)thyroid residual nail.Results The remnant thyroid sensitivity of ^(99)Tc^(m)O_(4)^(-)thyroid imaging was 70.44%(112/159),along with the specificity of 60.00%(3/5),the accuracy of 70.12%(115/164),the positive predictive value of 98.24%(112/114)and the negative predictive value of 3.75%(3/50).Gender and serum TSH level of patients between the two groups were both factors affecting ^(99)Tc^(m)O_(4)^(-)thyroid scan remnant positive(χ2=10.416,Z=2.78,all P<0.05),while there was no statistical significance for age,serum sTg and sTgAb levels between the two groups(Z value:0.738,1.470 and 0.909,all P>0.05).In addition,the 24h RAIU in the positive group of ^(99)Tc^(m)O_(4)^(-)thyroid scan remnant was significantly higher than that in the negative group(Z=7.607,P<0.05).The area under ROC curve for the prediction of the 24h RAIU for positive ^(99)Tc^(m)O_(4)^(-)thyroid thyroid imaging was 0.873,and the optimal threshold was

关 键 词：分化型甲状腺癌 ^(99)Tc^(m)O_(4)^(-)甲状腺显像 24h摄碘率 单光子发射计算机断层扫描 

分 类 号：R736.1[医药卫生—肿瘤]