血清胸苷激酶1、甲状腺球蛋白和甲状腺转移因子1在甲状腺良、恶性结节中的诊断价值

Diagnostic value of serum thymidine kinase 1, thyroglobulin and thyroid transfer factor-1 in benign and malignant thyroid nodules

目的探讨血清胸苷激酶1(S-TK1),甲状腺球蛋白(Tg)和甲状腺转移因子1(TTF-1)在鉴别甲状腺良、恶性结节中的临床价值。方法 2016年1月至2018年1月在我院诊断为甲状腺恶性结节的患者95例,为恶性结节组;选择同期在我院就诊良性甲状腺结节患者45例和健康体检者30例,分别为良性结节组和健康对照组。采用酶联免疫吸附法检测各组血清S-TK1,Tg和TTF-1水平。观察恶性结节组,良性结节组和健康对照组血清S-TK1,Tg和TTF-1水平变化,及恶性结节组血清S-TK1,Tg和TTF-1水平与甲状腺TNM分期的关系,及血清S-TK1,Tg和TTF-1水平在鉴别甲状腺良恶性结节的临床价值。结果恶性结节组S-TK1,Tg和TTF-1的水平明显高于良性结节组和健康对照组(P<0.01),良性结节组的TTF-1水平明显高于健康对照组(P<0.01),而良性结节组的S-TK1和Tg水平与健康对照组比较差异无统计学意义(P>0.05)。甲状腺恶性结节患者血清S-TK1,Tg和TTF-1水平随着肿瘤分期的升高而升高(P<0.01)。甲状腺恶性结节患者血清S-TK1水平与Tg(r=0.816,P<0.01)和TTF-1(r=0.753,P<0.01)水平呈正相关,而Tg水平和TTF-1水平呈正相关(r=0.687,P<0.01)。以S-TK1,Tg和TTF-1联合检测作为检验变量,以发生甲状腺恶性肿瘤为状态变量绘制ROC曲线,在诊断甲状腺恶性肿瘤方面联合检测的最佳截断值为>0.193,其灵敏度为91.6%,特异度为92.6%,其联合检测的曲线下面积为0.960明显优于S-TK1(Z=3.031,P<0.01),Tg(Z=4.477,P<0.01)和TTF-1(Z=4.483,P<0.01),而S-TK1,Tg和TTF-1的曲线下面积比较差异无统计学意义(P>0.05)。结论 S-TK1,Tg和TTF-1与甲状腺恶性结节的恶性程度密切相关,三者联合检测对于鉴别良恶性甲状腺结节具有较高的灵敏度和特异度。

Objective To investigate the clinical value of serum thymidine kinase 1(S-TK1),thyroglobulin(Tg)and thyroid transfer factor 1(TTF-1)in the differential diagnosis of benign and malignant thyroid nodules.Methods From January 2016 to January 2018,95 patients with malignant thyroid nodules were enrolled as malignant nodules group.45 patients with benign thyroid nodules and 30 healthy subjects were selected in our hospital as benign nodule group and healthy control group.Serum levels of S-TK1,Tg and TTF-1 were detected by enzyme-linked immunosorbent assay.The changes of serum S-TK1,Tg and TTF-1 levels in malignant nodules group,benign nodule group and healthy control group,and the relationship between serum S-TK1,Tg and TTF-1 levels and thyroid TNM staging in malignant nodules and the clinical value of serum S-TK1,Tg and TTF-1 levels were observed to identify the clinical value of benign and malignant thyroid nodules.Results The levels of S-TK1,Tg and TTF-1 in the malignant nodules group were significantly higher than those in the benign nodules group and the healthy control group(P<0.01).The TTF-1 level in the benign nodule group was significantly higher than that in the healthy control group(P<0.01),and the levels of S-TK1 and Tg in the benign nodule group were not significantly different from those in the healthy control group(P>0.05).The levels of serum S-TK1,Tg and TTF-1 in patients with thyroid malignant nodules increased with the increase of tumor stage(P<0.01).Serum S-TK1 levels in patients with thyroid malignant nodules were positively correlated with Tg(r=0.816,P<0.01)and TTF-1(r=0.753,P<0.01),while Tg levels were positively correlated with TTF-1 levels(r=0.687,P<0.01).The combined detection of S-TK1,Tg and TTF-1 was used as the test variable,and the ROC curve was drawn with the occurrence of thyroid malignancy as the state variable.The optimal cut-off value for joint detection in the diagnosis of thyroid malignancy was>0.193,and its sensitivity was 91.6%.The specificity was 92.6%,and the area under the combined detection curve was 0.960,which was significantly better than S-TK1(Z=3.031,P<0.01),Tg(Z=4.477,P<0.01)and TTF-1(Z=4.483,P<0.01),and the area under the curve of S-TK1,Tg and TTF-1 was not statistically significant(P>0.05).Conclusion S-TK1,Tg and TTF-1 are closely related to the malignant degree of malignant thyroid nodules.The combined detection of three markers has high sensitivity and specificity for the differential diagnosis of benign and malignant thyroid nodules.