Tg、TgAb及TSH在分化型甲状腺癌术前的预测分析

The prediction of risk of differentiated thyroid carcinoma with preoperative serum thyroid stimulating hormone, thyroglobulin and antithyroglobulin antibody

目的 探讨患者术前血清促甲状腺激素、甲状腺球蛋白（Tg）、抗甲状腺球蛋白抗体（TgAb）浓度在预测甲状腺癌中的价值.方法 对122例接受手术治疗的甲状腺结节患者进行术前研究,以术后病理结果作为甲状腺结节性质的诊断金标准进行对照,其中分化型甲状腺癌55例,良性结节67例.采用化学发光法测定Tg和TSH;放射免疫分析法测定TgAb;采用彩色多普勒超声诊断仪检查甲状腺组织和颈部淋巴结.结果 甲状腺癌组的术前血清Tg水平（24.09±64.59） ng/ml和甲状腺良性结节组（23.37±112.14）ng/ml间的差异无统计学意义（Z=-1.092,P＞0.05）;甲状腺癌组的TSH水平（2.32±2.28）mIU/L高于甲状腺良性结节组（1.75±1.22）mIU/L,（Z=-2.107,P＜0.05）;甲状腺癌组Tg联合TgAb的阳性率（72.7％）高于甲状腺良性结节组（55.2％）（χ^2=3.975,P＜0.05）.各指标预测甲状腺癌的受试者工作特征曲线示,TSH值的曲线下面积（AUC）为0.611[95％可信区间（95％CI）：0.509～0.713],P＜0.05,最佳临界值2.31 mIU/L,灵敏度和特异度分别为71.6％和50.9％;TSH∶Tg值的AUC为0.617（95％CI：0.518～0.716）,P＜0.05,最佳临界TSH∶Tg值为0.11 IU/mg,灵敏度和特异度分别为61.2％和50.9％;Tg曲线AUC＜0.5.结论 术前血清Tg的异常升高不是甲状腺癌的独立预测因素,但其结合TgAb阳性、TSH∶Tg值＞0.11 IU/mg可作为甲状腺癌的危险预测因素,可能是甲状腺超声检查的一种有效补充诊断手段.

Objective To explore the values of preoperative serum thyroid stimulating hormone,thyroglobulin and antithyroglobulin antibody in predicting the risk of differentiated thyroid carcinoma.Methods 122 patients with thyroid nodules who got operations were studied,among which 55 patients with differentiated thyroid carcinoma（54 papillary and 1 follicular）,67 cases with benign thyroid nodules （40 nodular goiter and 27 adenoma）.Serum thyroid-stimulating hormone （TSH） and thyroglobulin （Tg） were measured by chemiluminescence method,and antithyroglobulin antibody （TgAb） by radioimmunoassay.Thyroid tissues and cervical lymph nodes were checked using color doppler ultrasonic diagnostic instrument and the postoperative pathological results was regard as the gold standard of diagnosing thyroid cancer.Results Preoperative serum Tg levels in thyroid cancer group （24.09±64.59）ng/ml and benign thyroid nodules group （23.37 ± 112.14） ng/ml had no statistical differences （Z=1.092,P〉0.05）.TSH levels in thyroid carcinoma group （2.32±2.28） mIU/L were higher than that in benign thyroid nodules group （1.75 ±1.22） mIU/L （Z=2.107,P〈0.05）.The positive rate of Tg combined with TgAb in thyroid cancer group （72.7%） was higher than that in benign thyroid nodules group （55.2%） （χ^2=3.975,P〈0.05）.Receiver operating characteristic （ROC） curves showing sensitivity as a function of specificity were calculated for TSH,Tg levels and TSH ∶ Tg values to evaluate the potential accuracy of the three index as predicting differentiated thyroid carcinoma.The area under the curve （AUC） of TSH was 0.611 [95% confidence interval （95% CI）：0.509～0.713],P〈0.05.The optimum threshold in ROC curves of TSH was 2.31 mIU/L.The sensitivity and specificity of TSH were 71.6% and 50.9% respectively.The AUC of TSH ∶ Tg values was 0.617 （95% CI：0.518～0.716）,P〈0.05.The best critical value of TSH ∶ Tg was 0.11 IU/mg.The sensitivity and specificity of TSH ∶ Tg were 61.2% and 50.9% respectively.The AUC of Tg was less than 0.5.Conclusions Serum thyroglobulin elevated abnormally is not an independent predicting factor of differentiated thyroid cancer.The elevated Tg levels and/or positive TgAb and TSH ∶ Tg〉0.11 IU/mg can be used as effective supplementary means of ultrasound examination in predicting differentiated thyroid carcinoma.