术前C反应蛋白和促甲状腺激素水平检测诊断亚急性甲状腺炎的价值

Clincal value of preoperative C-reactive protein and thyroid stimulating hormone levels in diagnosis of subacute thyroiditis

目的 探讨术前血清C反应蛋白(CRP)和促甲状腺激素(TSH)水平在亚急性甲状腺炎中的诊断价值,为减少临床误治提供依据.方法 回顾性分析2011年5月至2020年1月安徽理工大学第一附属医院甲状腺结节手术病例3 525例,根据病理结果分为亚急性甲状腺炎组、慢性淋巴细胞性甲状腺炎组、甲状腺癌组、良性甲状腺结节组,选择符合入组条件的亚急性甲状腺炎组(A组)56例、桥本甲状腺炎(B组)56例,并按随机数字表法抽取甲状腺癌(C组)和良性甲状腺结节(D组)患者各56例,统计每组病例术前血清C反应蛋白(CRP)、促甲状腺激素(TSH)等指标并分析.结果 亚急性甲状腺炎误诊手术率1.7%(63例);A组CRP较B、C、D组均显著升高(Z=-3.024、-6.449、-6.012,均P<0.01);TSH在A组较B、C、D组明显降低(Z=-2.397、-3.877、-2.583,P=0.017、0.000、0.010),C组比D组显著升高(Z=-2.421,P=0.016);CRP诊断亚急性甲状腺炎ROC曲线下面积84.3% (95% CI:0.770~0.917),最佳截断值为3.62 mg/L时,诊断敏感性、特异度分别为69%、87%.结论 熟悉临床表现并将术前血清CRP和TSH水平作为甲状腺结节良恶性鉴别指标,可减少亚急性甲状腺炎误诊手术.

Objective To explore the diagnostic value of preoperative serum C-reactive protein(CRP)and thyroid stimulating hormone(TSH)levels in subacute thyroiditis,so as to provide evidence for reducing clinical mistreatment.Methods From May 2011 to January 2020,the elinical data of 3525 cases who received thyroid nodule surgery in the First Afiliated Hospital of Anhui University of Science&Technology were retrospectively analyzed.According 10 the results of pathology。the patients were lassifed as subacute thyroiditis group.chronic lymphocytic thyroiditis group,thyroid cancer group and benign thyroid nodule group.Fifty-six cases of subacute thyroiditis group(group A)and 56 cases of Hashimoto thyroiditis group(group B)were selected to meet the conditions of the group.Fifty-six cases of thyroid cancer group(group C)and 56 cases of benign thyroid nodule group(group D)were selected according to the random number table method.The serum levels of CRP,TSH and other indicators of each group were counted and analyzed before operation.Results The misdiagnosis rate of subacute thyroiditis was 1.7%.CRP level in group A was significantly higher than that in groups B,C and D(Z=-3.024,-6.449,-6.012,all P<0.01).The TSH level in group A was signifcantly lower than that in groups B,C and D(Z=-2.397,-3.877,-2.583,P=0.017,0.000 and 0.010),while that in group C was signifcanly higher than group D(Z=-2.421,P=0.016).The area under ROC curve for CRP diagnosis of subacute thyroiditis was 84.3%(95%Cl:0.770-0.917),when the optimal cutoff value was 3.62 mg/L,the diagnostie sensitivity and speificity were 69%and 87%,respectively.Conclusion Familiarity with clinical manifestations and preoperative serum CRP and TSH levels as dfferential indicators of benign and malignant thyroid nodules can reduce misdiagnosis of subacute thyroiditis.