血清TSH水平在评估分化型甲状腺癌中的作用研究

The study of the role of serum TSH level in evaluating differentiated thyroid cancer

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80.9%(89/110),特异度为74.4%(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82.7%(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 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,P0.05）.The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 80.9%（89/110）,the specificity was 74.4%（328/441）,and the area under receiver operating characteristic（ROC） curve was 0.660 [95% CI was（0.602,0.719）,P0.05].The sensitivity of TI-RADS in the diagnosis of DTC was 82.7%（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）,P0.05].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）,P0.05].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.