血清血管内皮生长因子诊断乳头状甲状腺癌的价值

Value of serum vascular endothelial growth factor level to the diagnosis of papillary thyroid carcinoma

目的探讨血清血管内皮生长因子(vascular endothelial growth factor, VEGF)在乳头状甲状腺癌(papillary thyroid carcinoma, PTC)诊断中的价值。方法拟行甲状腺全切术的甲状腺结节患者170例,均于术前采集静脉血,采用ELISA法检测血清VEGF水平。依据手术组织病理结果,将170例患者分为PTC组90例、甲状腺良性结节组54例、甲状腺腺瘤组14例、桥本甲状腺炎组12例,比较4组术前血清VEGF水平,分析血清VEGF与PTC临床病理特征的关系;绘制ROC曲线,评价血清VEGF诊断PTC的价值。结果 PTC组、甲状腺腺瘤组、桥本甲状腺炎组血清VEGF水平[232.5(152.5,324.3)、350.5(259.0,401.8)、293.0(197.0,752.8)ng/L]均高于甲状腺良性结节组[110.0(64.8,144.0)ng/L](P<0.05),且甲状腺腺瘤组、桥本甲状腺炎组高于PTC组(P<0.05),甲状腺腺瘤组与桥本甲状腺炎组比较差异无统计学意义(P>0.05)。血清VEGF水平在PTC患者年龄、性别、肿瘤直径、TNM分期、有无淋巴结转移及远处转移、BARF基因型上差异无统计学意义(P>0.05)。ROC曲线分析结果显示,血清VEGF以144.5 ng/L为最佳截断值,诊断PTC的AUC为0.834(95%CI:0.768~0.900,P<0.001),灵敏度为80%,特异度为78%。结论 PTC患者血清VEGF水平增高,且增高程度与临床病理学特征无明显关系;血清VEGF对PTC有一定的诊断价值。

Objective To investigate the value of serum vascular endothelial growth factor(VEGF)level to the diagnosis of papillary thyroid carcinoma(PTC).Methods The serum VEGF level was detected by ELISA before total thyroidectomy in 170 patients with thyroid nodules.According to the histopathological results,170 patients were divided into PTC group(n=90),benign nodule group(n=54),thyroid adenoma group(n=14)and Hashimoto’s thyroiditis group(n=12).The levels of VEGF were compared.The relationship between serum VEGF level and the clinicopathological features was analyzed.ROC curve was used to assess the value of VEGF level to the diagnosis of PTC.Results The serum VEGF level was higher in PTC group(232.5(152.5,324.3)ng/L),thyroid adenoma group(350.5(259.0,401.8)ng/L)and Hashimoto’s thyroiditis group(293.0(197.0,752.8)ng/L)than that in benign nodule group(110.0(64.8,144.0)ng/L)(P<0.05),higher in thyroid adenoma group and Hashimoto’s thyroiditis group than that in PTC group(P<0.05),and showed no significant difference between thyroid adenoma group and Hashimoto’s thyroiditis group(P>0.05).The VEGF level showed no significant differences in age,sex ratio,tumor diameter,TNM stage,lymph node metastasis,remote metastasis and BARF genotype in PTC patients(P>0.05).When the optimal cut-off value of VEGF was 144.5 ng/L,the AUC for diagnosing PTC was 0.834(95%CI:0.768-0.900,P<0.001),with a sensitivity of 80%and specificity of 78%.Conclusion The level of serum VEGF in PTC patients increases,and is not correlated with the clinicopathological features,and it has a diagnostic value for PTC.