高频超声联合血清学指标检查对甲状腺肿块良恶性的鉴别诊断价值  

Value of high-frequency ultrasound combined with serological indicators in distinguishing benign from malignant thyroid masses

作　　者：方海峰 Fang Haifeng(Department of Ultrasound,Ningbo Fourth Hospital,Ningbo 315700,Zhejiang Province,China)

机构地区：[1]宁波市第四医院超声科,宁波315700

出　　处：《中国基层医药》2025年第2期256-260,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨高频超声联合血清学指标检查对甲状腺肿块良恶性的鉴别诊断价值。方法选择宁波市第四医院2023年3月至2024年3月收治的甲状腺肿块患者103例为研究对象, 以病理结果为诊断金标准。所有患者行高频超声检查, 运用酶联免疫吸附法测定血清半乳糖凝集素-3(Galectin-3)和固醇调和元件结合蛋白1(SREBP1)水平, 运用化学电化学发光法测定促甲状腺激素受体抗体(TRAb)和促甲状腺激素(TSH)水平。统计高频超声对良恶性肿块鉴别诊断准确率;比较良恶性肿块患者影像学特征和血流分布等级情况;比较良恶性肿块血清Galectin-3、SREBP1、TRAb和TSH水平变化。结果 103例患者中, 手术病理检查显示, 恶性肿块30例, 其中乳头状癌24例, 滤泡状癌6例;良性肿块73例, 其中结节性甲状腺肿48例, 甲状腺炎性病变13例, 甲状腺腺瘤12例。高频超声诊断甲状腺恶性肿块准确率为90.00%(27/30)。超声检查显示, 甲状腺恶性肿块形态不规则[66.67%(20/30)]高于良性肿块[9.58%(7/73)]、低回声[83.33%(25/30)]高于良性肿块[21.92%(16/73)]、边界不清晰[63.33%(19/30)]高于良性肿块[10.96%(8/73)]、无声晕[90.00%(27/30)]高于良性肿块[46.58%(34/73)](χ^(2)=35.81、33.48、30.15、16.60, 均P < 0.001);甲状腺恶性肿块血流分布2~3级[70.00%(21/30)]高于良性肿块[20.55%(15/73)](χ^(2)=22.87, P < 0.05)。恶性肿块组血清Galectin-3[(2.64±0.52)μg/L]、SREBP1[(17.85±3.41)μg/L]、TRAb[(4.37±0.64)IU/L]和TSH[(5.35±1.27)mIU/L]均高于良性肿块组的(1.35±0.28)μg/L、(10.32±2.87)μg/L、(2.68±0.42)IU/L和(3.59±0.74)mIU/L(t=16.27、11.44、15.79、8.78, 均P < 0.001)。高频超声联合血清学指标鉴别良恶性肿块灵敏度[87.38%(90/103)]高于高频超声[69.90%(72/103)]与血清学指标单项检查[65.05%(67/103)](χ^(2)=4.76、5.68, 均P < 0.05);高频超声联合血清学指标鉴别良恶性肿块特异度[97.09%(100/103)]高于血清学指标单项检查[75.73%(78Objective:To investigate the value of high-frequency ultrasound combined with serological indicators in distinguishing benign from malignant thyroid masses.Methods:This study included 103 patients with thyroid masses admitted to Ningbo Fourth Hospital from March 2023 to March 2024.Pathological results were used as the gold standard for diagnosis.All patients underwent high-frequency ultrasound examinations.Enzyme-linked immunosorbent assay was performed to determine serum levels of Galectin-3 and Sterol Regulatory Element Binding Protein 1.Chemiluminescent immunoassay was performed to measure the levels of thyroid stimulating hormone receptor antibodies(TRAb)and thyroid stimulating hormone(TSH).The accuracy of high-frequency ultrasound in distinguishing benign from malignant thyroid masses was calculated.The imaging characteristics and blood flow distribution patterns were compared between benign and malignant thyroid masses.Serum levels of Galectin-3,SREBP1,TRAb,and TSH were also compared between benign and malignant thyroid masses.Results:Among the 103 patients,surgical pathology revealed 30 cases of malignant thyroid masses,including 24 cases of papillary carcinoma and 6 cases of follicular carcinoma.There were also 73 cases of benign thyroid masses,comprising 48 cases of nodular goiter,13 cases of thyroiditis,and 12 cases of thyroid adenoma.The accuracy of high-frequency ultrasound in diagnosing thyroid malignancies was 90.00%(27/30).Ultrasound findings showed that the characteristics of malignant thyroid masses included irregular shape[66.67%(20/30)vs.9.58%(7/73)],hypoechogenicity[83.33%(25/30)vs.21.92%(16/73)],and unclear margins[63.33%(19/30)vs.10.96%(8/73)],as well as absence of a halo[90.00%(27/30)vs.46.58%(34/73)]compared with benign thyroid masses(χ^(2)=35.81,33.48,30.15,16.60,all P<0.001).Additionally,the blood flow distribution in malignant thyroid masses was classified as levels 2-3 in 70.00%(21/30),which was significantly higher than that in benign thyroid masses[20.55%(15/73),χ^(2)=22.87,P<0.05]

关 键 词：甲状腺结节 超声检查 半乳糖凝集素3 胆固醇调节元件结合蛋白质类 受体 甲状腺激素 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581.3[医药卫生—诊断学]