血清miRNA-363联合超声弹性成像在诊断老年甲状腺乳头状癌中的临床意义

Clinical Significance of Serum miRNA-363 Combined with Ultrasound Elasticity Imaging in Diagnosing Papillary Thyroid Carcinoma in the Elderly

目的探讨血清miRNA-363联合超声弹性评分(ES)和弹性应变比值(SR)在老年甲状腺乳头状癌中的临床意义。方法选择2017年1月—2018年12月在复旦大学附属华山医院静安分院诊断为甲状腺乳头状癌患者118例,为甲状腺乳头状癌组;选择同期75例诊断为老年甲状腺腺瘤者为对照组。采用实时定量PCR测定2组血清miRNA-363,采用超声测定ES和SR。结果甲状腺乳头状癌组的血清miRNA-363较甲状腺腺瘤组降低(P<0.01),而甲状腺乳头状癌组的ES和SR水平高于甲状腺腺瘤组(P<0.01)。甲状腺乳头状癌患者血清miRNA-363与ES(r=-0.762,P<0.01)和SR(r=-0.813,P<0.01)呈负相关,同样甲状腺乳头状癌患者ES与SR呈正相关(r=0.781,P<0.01)。以血清miRNA-363,ES和SR联合检测作为检验变量,以发生甲状腺乳头状癌为状态变量绘制ROC曲线,联合检测的灵敏度为94.1%,特异性为76.0%,其AUC为0.940联合检测的曲线下面积优于miRNA-363(Z=3.780,P<0.01),ES(Z=5.256,P<0.01)和SR(Z=4.976,P<0.01),而血清miRNA-363,ES和SR的曲线下面积之间的比较差异无统计学意义(P>0.05)。结论血清miRNA-363联合声弹性成像检测与甲状腺乳头状癌的恶性程度相关,在诊断老年甲状腺乳头状癌具有较高的灵敏度和特异性,在早期诊断甲状腺乳头状癌具有重要的临床意义。

Objective To explore the clinical significance of serum miRNA-363 combined with ultrasound elasticity score (ES) and strain ratio (SR) in diagnosing papillary thyroid carcinoma in the elderly.Methods 118 cases with papillary thyroid carcinoma were selected in papillary thyroid carcinoma group while 75 elderly with thyroid adenoma in control group during the period from Jan.,2017 to Dec.,2018;real-time quantitative PCR was applied in detecting the serum miRNA-363 while ultrasound in determining ES and SR.Results The level of serum miRNA-363 was lower while the levels of ES and SR was higher in papillary thyroid carcinoma group than those in control group (P<0.01);the serum miRNA-363 of the cases with papillary thyroid carcinoma was in negative correlation to ES ( r=-0.762,P<0.01) and SR ( r=-0.813,P<0.01), and the ES of the cases with papillary thyroid carcinoma was in positive correlation to their SR ( r=0.781,P<0.01);taking the combined detection of serum miRNA-363,ES and SR as the test variable and the occurrence of thyroid papillary carcinoma as the state variable,the ROC curve was drawn,the sensitivity of the combined detection was 87.3%,the specificity was 94.7%,and the AUC was 0.940;the AUC of the combined detection was superior to those of miRNA-363 (Z=3.780, P<0.01),ES (Z=5.256,P<0.01) and SR (Z=4.976,P<0.01);there was no significant difference in AUC among serum miRNA-363,ES and SR (P>0.05).Conclusions The serum miRNA-363 combined with ultrasound elasticity imaging is of correlation with the malignant degree of papillary thyroid carcinoma;it is of high sensitivity and specificity in the diagnosis of papillary thyroid carcinoma in the elderly and has an important clinical significance in early diagnosis of papillary thyroid carcinoma.