中国普外基础与临床杂志

中国普外基础与临床杂志

血清 TSH 水平在评估分化型甲状腺癌中作用的研究

查看全文

目的 探讨血清中促甲状腺素(thyroid stimulating hormone,TSH)水平在评估分化型甲状腺癌(DTC)中的作用。 方法 回顾性收集佳木斯大学附属第一医院 2017 年 8 月至 2017 年 12 月期间以甲状腺结节收治入院并符合纳入标准的患者共计 551 例,根据术后病理学结果将患者分为良性组 441 例和 DTC 组 110 例,比较 2 组患者术前血清 TSH 水平的差异,并探索血清 TSH 水平、甲状腺影像报告与数据系统(thyroid imaging reporting and data system,TI-RADS)分级单独及联合对 DTC 的诊断价值。 结果 DTC 组患者的术前 TSH 水平较高(Z=5.198,P<0.05)。血清 TSH 水平诊断 DTC 的灵敏度为 78.2%(89/110),特异度为 67.8%(328/441),受试者工作特征(receiver operating characteristic,ROC)曲线下面积为 0.660 [95%CI 为(0.602,0.719),P<0.05];TI-RADS 分级诊断 DTC 的灵敏度为 83.5%(91/110),特异度为 73.5%(324/441),ROC 曲线下面积为 0.772 [95%CI 为(0.711,0.823),P<0.05];血清 TSH 水平联合 TI-RADS 分级诊断 DTC 的灵敏度为 91.8%(101/110),特异度为 87.5%(386/441),ROC 曲线下面积为 0.831 [95%CI 为(0.786,0.876),P<0.05]。 结论 术前血清 TSH 水平可能是 DTC 发生的潜在危险因素;术前血清 TSH 水平及 TI-RADS 分级两者联合能提高术前诊断 DTC 的准确率,不但能减少 DTC 的误诊,亦能避免过度治疗。

Objective To investigate the role of preoperative serum thyroid stimulating hormone (TSH) in evaluating differentiated thyroid cancer (DTC). Methods A total of 551 patients with thyroid nodules met the study criteria, who got treatment in the First Affiliated Hospital of Jiamusi University between Aug. 2017 and Dec. 2017. And the the patients were divided into DTC group (n=110) and benign group (n=441) according to the postoperative pathological results. The difference of serum TSH level between the 2 groups was compared and then explored the diagnostic significance of serum TSH level, thyroid imaging report and data system (TI-RADS), and serum TSH combined with TI-RADS. Results The serum TSH level was higher in the DTC group than that of the benign group (Z=5.198, P<0.05). The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 78.2% (89/110), the specificity was 67.8% (328/441), and the area under receiver operating characteristic (ROC) curve was 0.660 [95%CI was (0.602, 0.719), P<0.05]. The sensitivity of TI-RADS in the diagnosis of DTC was 83.5% (91/110), the specificity was 73.5% (324/441), and the area under the ROC curve was 0.772 [95%CI was (0.711, 0.823), P<0.05]. The sensitivity of preoperative serum TSH combined with TI-RADS in the diagnosis of DTC was 91.8% (101/110), the specificity was 87.5% (386/441), and the area under the ROC curve was 0.831 [95%CI was (0.786, 0.876), P<0.05]. Conclusions Preoperative serum TSH level may be a potential risk factor for the occurrence of DTC. Preoperative serum TSH level combined with TI-RADS classification can improve the accuracy of preoperative diagnosis of DTC, not only to reduce the misdiagnosis of thyroid cancer, but also can avoid excessive treatment.

关键词: 分化型甲状腺癌; 促甲状腺素; 甲状腺影像报告与数据系统; 诊断价值

Key words: differentiated thyroid cancer; thyrotropin; thyroid imaging report and data system; diagnostic value

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 吴毅. 关于甲状腺结节诊断和治疗的若干思考. 中国实用外科杂志, 2010, 30(10): 821-823.
2. 中华医学会内分泌学分会中华医学会外科学分会内分泌学组中国抗癌协会头颈肿瘤专业委员会中华医学会核医学分会. 甲状腺结节和分化型甲状腺癌诊治指南. 中华内分泌代谢杂志, 2012, 28(10): 779-797.
3. Haugen B, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2015.
4. Moon HJ, Son E, Kim EK, et al. The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Ann Surg Oncol, 2012, 19(1): 52-59.
5. Choi SH, Han KH, Yoon JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf), 2011, 74(6): 776-782.
6. Boelaert K, Horacek J, Holder RL, et al. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab, 2006, 91(11): 4295-4301.
7. Fiore E, Rago T, Provenzale MA, et al. Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocr Relat Cancer, 2009, 16(4): 1251-1260.
8. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf), 1995, 43(1): 55-68.
9. McLeod DS, Watters KF, Carpenter AD, et al. Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab, 2012, 97(8): 2682-2692.
10. 董屹婕, 詹维伟. 超声引导下细针穿刺在甲状腺结节诊断和鉴别诊断中的价值. 中国实用外科杂志, 2015, 35(6): 613-319.
11. 田文, 郗洪庆. 甲状腺癌病人生存现状分析. 中国实用外科杂志, 2016, 36(5): 489-493.
12. Pellegriti G, Frasca F, Regalbuto C, et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol, 2013, 2013: 965212.
13. 孙彤, 田晶, 李辰运, 等. 相关实验室检查和超声特征在分化型甲状腺癌与结节性甲状腺肿鉴别诊断中的意义. 中国超声医学杂志, 2017, 33(10): 874-878.
14. 陈晓康, 陈少华, 吕国荣. 超声 TI-RADS 分类对甲状腺结节的诊断价值. 中国超声医学杂志, 2012, 28(12): 1066-1068.
15. Liu B, Liang J, Zheng Y, et al. Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience. Eur Radiol, 2015, 25(3): 624-634.
16. Rahal A Junior, Falsarella PM, Rocha RD, et al. Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1, 000 nodules. Einstein (Sao Paulo), 2016, 14(2): 119-123.
17. 余小琴, 郭莉, 何惠丽, 等. TI-RADS 分类系统联合超声造影对甲状腺结节良恶性鉴别诊断价值. 医学影像学杂志, 2017, 27(6): 1056-1072.
18. 徐晓波, 刘文勇. 血清 TSH 浓度与结节性甲状腺肿合并甲状腺癌关系的研究. 中国普外基础与临床杂志, 2012, 19(1): 58-61.
19. Williams ED. Mechanisms and pathogenesis of thyroid cancer in animals and man. Mutat Res, 1995, 333(1-2): 123-129.
20. 马峻峰, 唐波, 李铁汉, 等. 促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用. 中国普外基础与临床杂志, 2009, 16(5): 348-350, 355.
21. Haymart MR, Repplinger DJ, Leverson GE, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab, 2008, 93(3): 809-814.
22. Onigata K, Szinnai G. Resistance to thyroid hormone. Endocr Dev, 2014, 26(3): 118-129.
23. Azizi G, Keller JM, Lewis M, et al. Association of Hashimoto’s thyroiditis with thyroid cancer. Endocr Relat Cancer, 2014, 21(6): 845-852.
24. 龚卫东, 黄堃, 王南鹏, 等. 桥本甲状腺炎合并甲状腺癌的诊断与治疗. 中国普外基础与临床杂志, 2013, 20(6): 643-647.
25. Feldt-Rasmussen U, Rasmussen AK. Autoimmunity in differentiated thyroid cancer: significance and related clinical problems. Hormones (Athens), 2010, 9(2): 109-117.