探讨剪切波弹性成像、25-羟维生素D及甲状腺球蛋白抗体对甲状腺良恶性结节的诊断价值

Valuation of shear wave elastography,25-hydroxyvitamin D and thyroglobulin antibody in differential diagnosis of thyroid nodules.

目的探讨剪切波弹性成像(SWE)、25-羟维生素D[25(OH)D]及甲状腺球蛋白抗体(TgAb)在甲状腺结节良恶性鉴别诊断的意义,以提高甲状腺癌的诊断准确性。方法回顾性选取2018年11月至2019年6月在秦皇岛市第一医院因甲状腺结节手术的152例甲状腺结节患者(152处甲状腺结节)作为研究对象。其中良性结节69例,恶性结节83例。比较2组患者血清25(OH)D、TgAb及SWE定量测值杨氏模量最大值(YMEmax);以手术后的病理结果为诊断金标准构建受试者工作特征(ROC)曲线,评价YMEmax、25(OH)D水平及TgAb在甲状腺良恶性结节诊断方面的价值。结果与良性结节组比较,甲状腺恶性结节组YMEmax、TgAb阳性率明显升高,而血清25(OH)D水平明显降低,差异均有统计学意义(P<0.05)。以甲状腺结节的YMEmax48 kPa为临界值时,诊断结节良恶性的敏感性为80.70%、特异性为85.50%,ROC曲线下面积为0.903;以25(OH)D水平诊断良恶性结节的敏感性、特异性分别为22.90%、34.80%,准确度为57.89%;以TgAb阳性诊断良恶性结节的敏感性、特异性分别为22.89%、89.86%,准确度为53.29%。剪切波弹性成像、25(OH)D水平及TgAb阳性率联合诊断结节良恶性的敏感性、特异性分别为90.40%、91.30%,准确度为90.79%。结论超声鉴别诊断甲状腺结节良恶性的诊断价值较高,SWE、25(OH)D水平及TgAb阳性率联合可进一步提高鉴别诊断甲状腺良恶性结节的水平。

Objective To evaluate shear wave elastography(SWE),25-hydroxyvitamin D[25(OH)D]and thyroglobulin antibody(TgAb)for distinguishing benign and malignant thyroid nodules,to improve the diagnostic accuracy of thyroid cancer.Methods A total of 152 patients referred for surgery of thyroid nodules,69 were benign and 83 were malignant.The 25(OH)D,TgAb and YMEmax of the two groups were compared.Construction of ROC curve to evaluate the value of YMEmax,TI-RADS,and TgAb in the diagnosis of benign and malignant thyroid nodules.Results Compared with benign thyroid nodule group,YMEmax and TgAb was significantly increased,while 25(OH)D was significantly lower in malignant thyroid nodule group(P<0.05).When the maximum Young's modulus was 48 kPa,the sensitivity and specificity for diagnosis of benign and malignant nodules were 80.7%and 85.5%,and the area under ROC curve was 0.903(P<0.05).The sensitivity and specificity of TgAb diagnosis for malignant nodules were 22.89%and 89.86%,and the accuracy was 53.29%(P<0.05).The combination of SWE,25(OH)D and TgAb,the sensitivity and specificity were 90.40%and 91.30%,and the accuracy was 90.79%(P<0.05).Conclusion Ultrasound has high value in the diagnosis of thyroid nodules.The combination of SWE,TI-RADS and TgAb improved the diagnostic of malignant thyroid nodules.