高频彩色多普勒超声和血清甲状腺球蛋白在分化型甲状腺癌^(131)I清除残余甲状腺后随访中的应用

Application of high-frequency Doppler ultrasonography and serum thyroglobulin in follow-up of differentiated thyroid cancer after (131)~I remnant ablation

目的探讨高频彩色多普勒超声检查和血清甲状腺球蛋白(Tg)检测在分化型甲状腺癌(DTC)131I清除残余甲状腺后随访中的临床应用价值。方法回顾性分析92例接受甲状腺近全或全切除术联合131I清除残余甲状腺治疗的DTC患者资料。根据血清Tg水平分为血清Tg<2ng/ml组、2~10ng/ml组及>10ng/ml组,比较各组间DTC复发转移率的差异。以临床随访131I全身扫描或病理结果为金标准,评价高频彩色多普勒超声、血清Tg检测及二者联合应用诊断DTC复发转移的效能。结果 92例中,39例DTC复发转移。血清Tg<2ng/ml组、2~10ng/ml组及>10ng/ml组复发转移率分别为14.81%(8/54)、41.67%(5/12)及100%(26/26),组间差异有统计学意义(P<0.05)。高频彩色多普勒超声诊断DTC复发转移的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为89.74%(35/39)、90.57%(48/53)、90.22%(83/92)、87.50%(35/40)、92.31%(48/52),血清Tg检测分别为79.49%(31/39)、86.79%(46/53)、83.70%(77/92)、81.58%(31/38)及85.19%(46/54),二者联合应用分别为94.87%(37/39)、86.79%(46/53)、90.22%(83/92)、84.09%(37/44)、95.83%(46/48)。结论高频彩色多普勒超声检查和血清Tg检测均可用于DTC患者131I清除残余甲状腺后的随访,二者联合应用有利于及早发现复发转移。

Objective To investigate the application value of high-frequency Doppler ultrasonography and detection of serum thyroglobulin（Tg）in the follow-up of differentiated thyroid cancer（DTC）after 131 I remnant ablation.Methods A retrospective analysis of 92 patients underwent near-total or total thyroidectomy and 131 I remnant ablation was performed.The patients were divided into 3 groups according to serum Tg concentrations,included serum Tg〈2ng/ml,2—10ng/ml and10ng/ml groups.The ratios of recurrence metastasis were compared among 3 groups.The diagnostic efficiencies of high-frequency Doppler ultrasonography,serum Tg detection and the combination of two methods were evaluated,taking the results of 131I-whole body scan or pathology during follow-up as the gold standard.Results There were 39 of 92patients of recurrence metastasis.The ratios of recurrence metastasis was 14.81%（8/54）in serum Tg〈2ng/ml group,41.67%（5/12）in serum Tg 2—10ng/ml group and 100%（26/26）in serum Tg〉10ng/ml group,respectively.There was statistical difference among 3groups（P〈0.05）.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value in the diagnosis of DTC recurrence metastasis was 89.74%（35/39）,90.57%（48/53）,90.22%（83/92）,87.50%（35/40）and 92.31%（48/52）of high-frequency Doppler ultrasonography,79.49%（31/39）,86.79%（46/53）,83.70%（77/92）81.58%（31/38）and 85.19%（46/54）of serum Tg detection,94.87%（37/39）,86.79%（46/53）,90.22%（83/92）,84.09%（37/44）and 95.83%（46/48）of two methods combination,respectively.Conclusion The high-frequency Doppler ultrasonography and serum Tg detection are valuable for the follow-up of DTC patients after 131 I remnant ablation.The combination of two methods is helpful to detect the recurrence metastasis in early.