甲状腺功能测定在甲状腺癌诊断中的作用

Diagnostic value of thyroid function parameters in thyroid cancer

目的评估甲状腺手术患者的甲状腺功能指标和超声检查,预测其与甲状腺癌的关系,以期寻求更好的术前诊断方法。方法回顾性分析2015年1月—2015年12月在中国医科大学附属盛京医院行甲状腺手术的患者,分析患者术前的甲状腺功能、彩色B超,结合性别、年龄及最终病理结果,评估正常范围内的甲状腺功能指标对甲状腺癌的预测水平。结果最终纳入908例患者。其中,恶性结节患者244例,良性结节患者664例。患者性别构成、甲状腺素(T4)比较,差异无统计学意义(P>0.05);而年龄、血清促甲状腺激素(TSH)水平、三碘甲状腺原氨酸(T3)、甲状腺过氧化物酶抗体(TPOAb)阳性率及甲状腺球蛋白抗体(TgAb)阳性率比较,差异有统计学意义(P<0.05)。将TSH、T3水平四等分,随着TSH水平上升,T3水平降低,患者恶性率增加(P<0.05)。血清TSH在2个水平较高的四分位区间比最低水平的四分位区间患者患恶性肿瘤的风险更大[OR=2.410(95%CI:1.552,3.743)]、[OR=2.508(95%CI:1.613,3.899)]。甲状腺癌的患病风险与血清TSH呈正比。而T3在2个相对较低水平的第2和第4四分位区间比最高水平的四分位区间患恶性肿瘤的风险高[OR=2.410(95%CI:1.552,3.743)]、[OR=2.508(95%CI:1.613,3.899)]。绘制受试者工作特征曲线,测得临界值TSH=1.4861μIU/ml,T3=4.94 pmol/L。诊断实验中,T3分别联合TSH、TPOAb及TgAb,TSH分别联合TPOAb、TgAb的特异性较高。结论甲状腺功能参数可作为一种可靠的甲状腺乳头状癌的辅助诊断指标。

Objective To evaluate the thyroid function associated with the ultrasound parameters among thyroid malignancy patients and to seek for a better measure of preoperative diagnosis.Methods Patients undergoing thyroid operation from January 2015 to December 2015 at a single hospital were enrolled for the research.The preoperative thyroid function,color Doppler ultrasound,combined with gender,age and final pathological results were used to evaluate the normal range of thyroid function indicators for the prediction of thyroid cancer.Results Totally 908 patients were included.Among them,244 were malignant and 664 benign.There was no significant difference in sex composition and thyroxine(T4)(P>0.05);there were significant differences in age,TSH level,TPOAb and TGAb(P<0.05);with the increase of TSH,T3 decreased and the malignant rate increased(P<0.05);patients with serum TSH in the two higher quartile ranges were at higher risk of malignancy than those in the lowest quartile range[OR=2.410(95%CI:1.552,3.743)],[OR=2.508(95%CI:1.613,3.899)].The risk of thyroid cancer was positively correlated with serum TSH.However,T3 is at a higher risk of malignancy in the second and fourth quartiles of two relatively lower concentrations[OR=2.410(95%CI:1.552,3.743)],[OR=2.508(95%CI:1.613,3.899)].The critical values TSH=1.4861μIU/ml,T3=4.94 pmol/L were measured.In the diagnosis experiment,T3 combined with TSH,TPOAb and TGAb respectively,TSH combined with TPOAb and TGAb respectively have high specificity.Conclusions The parameters of thyroid function might be helpful to predictive of thyroid papillary cancinoma as a dependent factor.