| 吴华臣,黄迎春,韩欣红,尹旭莲,李立华,车艳玲.术前血清TSH水平联合多普勒超声对分化型甲状腺癌的诊断价值[J].,2018,(13):2494-2498 |
| 术前血清TSH水平联合多普勒超声对分化型甲状腺癌的诊断价值 |
| Diagnostic Value of Preoperative Serum TSH Level Combined with Doppler Ultrasonography for Differentiated Thyroid Carcinoma |
| 投稿时间：2017-10-07 修订日期：2017-10-30 |
| DOI：10.13241/j.cnki.pmb.2018.13.019 |
| 中文关键词: 术前 血清TSH水平 多普勒超声 分化型甲状腺癌 诊断价值 |
| 英文关键词: Preoperative Serum TSH level Doppler ultrasonography Differentiated thyroid carcinoma Diagnostic value |
| 基金项目:卫生部医药卫生科技发展项目（W2013GJ09） |
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| 中文摘要: |
| 摘要 目的：研究术前血清促甲状腺激素（TSH）水平联合多普勒超声对分化型甲状腺癌（DTC）的诊断价值。方法：选择从2015年1月到2017年6月在北京市第一中西医结合医院诊治的甲状腺结节患者528例作为研究对象。经病理学诊断显示DTC患者268例，记为观察组；良性甲状腺结节患者260例，记为对照组，检测并对比两组超声指标，两组TSH水平分布情况，分析观察组患者血清TSH水平与其颈淋巴结转移及肿瘤直径的关系，以及术前血清TSH联合多普勒超声对DTC的诊断价值。结果：观察组病灶数目为单个、病灶大小为小结节以及有沙粒样钙化者占比均分别明显高于对照组，差异均有统计学意义（均P＜0.05）。观察组TSH水平为2.20～4.20 μIU/mL及＞4.20 μIU/mL者占比均分别明显高于对照组，且＜0.27 μIU/mL、0.27～1.44 μIU/mL及1.45～2.19 μIU/mL者占比均分别明显低于对照组，差异均有统计学意义（均P＜0.05）。观察组患者中，有颈淋巴结转移者的TSH水平明显高于无转移者，肿瘤直径为2～4 cm和＞4 cm者的TSH水平均分别明显高于＜2 cm者，且肿瘤直径＞4 cm者也明显高于2～4 cm者，差异均有统计学意义（均P＜0.05）。术前血清TSH联合多普勒超声对DTC的诊断结果中，灵敏度为73.88%（198/268），特异度为82.31%（214/260），准确度为78.03%（412/528），均分别高于单纯超声诊断的57.46%（154/268），75.77%（197/260），66.48%（351/528），差异有统计学意义（P＜0.05）。联合诊断的ROC曲线下面积是0.847，其中TSH诊断临界值是3.153 mIU/L。结论：应用术前血清TSH水平与多普勒超声的联合诊断方式能够有效诊断DTC患者，临床上可考虑将此种联合诊断方式进行推广，从而为DTC患者的诊治及病情评价发挥指导作用，值得给予重视。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the diagnostic value of preoperative serum thyroid stimulating hormone (TSH) level combined with Doppler ultrasonography for differentiated thyroid carcinoma (DTC). Methods: 528 patients with thyroid nodules who were treated in Beijing First Hospital of Integrated Chinese and Western Medicine from January 2015 to June 2017 were selected as the subjects, 268 patients with DTC who were diagnosed by pathologically were recorded as the observation group, another 260 patients with benign thyroid nodules were recorded as the control group. The ultrasonic indexes, level of TSH in the two groups were detected and compared. The relationship between serum TSH level, lymph node metastasis and tumor diameter in the observation group was analyzed, and the diagnostic value of preoperative serum TSH combined with Doppler ultrasound in DTC was observed. Results: The number of lesions was single, the size of the lesion was small nodules, and the rate of sand like calcificationin the observation group were significantly higher than those of the control group, the differences were statistically significant (P<0.05). The proportion of patients with TSH level ranged from 2.20 to 4.20 μIU/mL and > 4.20 μIU/mL in the observation group were significantly higher than those in the control group, and the proportion of patients with TSH level ranged from<0.27 IU/mL, 0.27 to 1.44 mu IU/mL and 1.45 to 2.19 IU/mL were significantly lower than those of the control group, the differences were statistically significant (P<0.05). The TSH level of the patients with cervical lymph node metastasis in the observation group were significantly higher than those in the non metastasis group, the TSH level of patients with tumor diameter ranged from 2 to 4 cm and > 4 cm were significantly higher than those patients with < 2 cm, and the diameter of tumor >4 cm of patients was significantly higher than those patients with 2 to 4 cm, the differences were statistically significant (P<0.05). The sensitivity of preoperative TSH combined with Doppler ultrasonography for DTC diagnosis was 73.88% (198/268), specificity was 82.31% (214/260), and accuracy was 78.03% (412/528), which were significantly higher than those of pure ultrasound diagnosis of 57.46% (154/268), 75.77% (197/260), 66.48% (351/528), the differences were statistically significant (P<0.05). The area under the ROC curve of combined diagnosis was 0.847, in which the critical diagnostic value of TSH was 3.153 mIU/L. Conclusion: The DTC patients can be diagnosed by preoperative serum TSH level combined with Doppler ultrasonography effectively,this combined diagnosis can be popularized in clinical practice, so as to play a guiding role in the diagnosis, treatment and disease evaluation of patients with DTC, which is worth to be pay attention. |
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