细针穿刺洗脱液检测甲状旁腺激素水平在甲状腺癌根治术中的应用研究

Application of fine-needle puncture eluent to detect parathyroid hormone in radical thyroidectomy

目的探讨细针穿刺洗脱液检测甲状旁腺激素(PTH)水平在甲状腺癌根治术中的临床价值。方法选取2016年12月—2018年12月于武汉科技大学附属孝感医院行甲状腺癌根治术的患者84例。术中对目标组织(高度怀疑甲状旁腺组织)及非目标组织(甲状腺组织、淋巴样组织)行直视下细针穿刺,采用电化学发光免疫分析法检测穿刺洗脱液PTH水平,结合术后病理学检查结果,分析不同组织穿刺洗脱液PTH水平的差异。结果确诊甲状旁腺组织(AT组)穿刺洗脱液PTH水平为(536.90±32.02)pg/mL,误诊为甲状旁腺组织(AF组)穿刺洗脱液PTH水平为(63.86±5.44)pg/mL,确诊甲状腺组织(B组)穿刺洗脱液PTH水平为(53.61±3.07)pg/mL,淋巴样组织(C组)穿刺洗脱液PTH水平为(58.71±2.89)pg/mL。4组穿刺洗脱液PTH水平比较,差异有统计学意义(P<0.05)。进一步两两比较,AF组、B组、C组均低于AT组(P<0.05);AF组、B组、C组比较,差异无统计学意义(P>0.05)。结论细针穿刺洗脱液检测PTH水平对于甲状腺癌手术中甲状旁腺的鉴别和保护具有重要意义,值得临床推广应用。

Objective To evaluate the clinical value of fine-needle aspiration(FNA)plus assaying parathyroid hormone(PTH)in the eluent of FNA samples for identification of parathyroid gland during thyroidectomy.Methods Totally 84 patients with thyroidectomy were treated with fine-needle puncture under direct vision for highly suspected parathyroid tissue and thyroid tissue and lymphadenoid tissue.The PTH levels were detected by electrochemical luminescence immunoassay for the eluent of puncture,and the corresponding tissues were sent for pathological examination simultaneously.The PTH levels in the eluent from different tissues were compared.Results The PTH value of confirmed-parathyroid tissue(AT group)was(536.90±32.02)pg/mL,misdiagnosed-parathyroid tissue(AF group)was(63.86±5.44)pg/mL,confirmed-thyroid(B group)was(53.61±3.07)pg/mL,and lymphadenoid tissue was(58.71±2.89)pg/mL.The differences between AT group VS AF group,AT group VS B group,and AT group VS C group were all statistically significant(P<0.05).PTH level of AT group was higher than that of B group in paired analysis(P<0.05).No significant difference was found between the non parathyroid groups(P>0.05).Conclusion Detection of PTH value in the eluent is of great significance for identification of parathyroid gland during thyroidectomy,which is worthy of clinical promotion.