超声与血清Cla-1、Gal-1联合诊断桥本甲状腺炎合并甲状腺结节的研究

Study on the Combination of Ultrasound and Serum CLA-1 and Gal-1 in the Diagnosis of Hashimoto Thyroiditis complicated with Thyroid Nodules

目的 探讨超声结合血清紧密连接蛋白1(Cla-1)、半乳糖血凝素1(Gal-1)在桥本甲状腺炎合并甲状腺结节患者中的诊断价值。方法 选取2019年4月-2021年5月我院收治的120例桥本甲状腺炎合并甲状腺结节患者作为研究对象,同期选取40例健康人群作对照组。患者于术前进行超声检查,同时受试者均进行血清Cla-1、Gal-1检查;术后以病理检查结果作为金标准,比较超声检查结果及血清Cla-1、Gal-1诊断效能。结果 病理检查结果显示良性结节84例、恶性结节36例;超声结合TI-RADS分级标准检查出良性结节77例,恶性结节43例,灵敏度为88.89%(32/36)、特异性为86.90%(73/84)、准确率为87.50%(105/120)。良、恶性结节组血清Cla-1、Gal-1水平高于对照组(P<0.05),且恶性结节组Cla-1、Gal-1水平高于良性结节组(P<0.05)。经ROC曲线分析结果显示,血清Cla-1、Gal-1单独与联合诊断的AUC分别为0.712、0.738、0.884,灵敏度与特异度分别为45.0%、97.5%,85.0%、57.5%,82.5%、80.0%。Cla-1联合Gal-1诊断效能显著优两者单独诊断(P<0.05)。结论 超声对桥本甲状腺炎合并甲状腺结节检出率高,但对于良恶性结节诊断不准确,血清Cla-1、Gal-1水平在甲状腺恶性结节中表达显著上升,灵敏度与特异性更高,两种方式联合可显著提高桥本甲状腺炎合并甲状腺结节诊断效能。

Objective To investigate the diagnostic value of ultrasound combined with serum Claudin-1(Cla-1)and Galectin-1(Gal-1)in Hashimoto′s thyroiditis patients with thyroid nodules.Methods One hundred and twenty patients with Hashimoto′s thyroiditis complicating thyroid nodules and another 40 healthy individuals in our hospital from April 2019 to May 2021 were selected.All patients underwent ultrasound examination and the detections of serum Cla-1 and Gal-1;Then the diagnostic efficacy of ultrasound examination combined with serum Cla-1 and Gal-1 was evaluated with postoperative pathological findings as gold standard.Results Pathological findings revealed benign nodules in 84 cases and malignant nodules in 36 cases.Ultrasound detected 77 benign nodules and 43 malignant nodules, with a sensitivity, specificity and accuracy of 88.89%(32/36),86.90%(73/84)and 87.50%(105/120).Compared with control group, serum Cla-1 and Gal-1 levels were elevated in patients with nodules(P<0.05),and the elevation was more significant in malignant nodule group than in benign nodule group(P<0.05).In clinical diagnosis of Hashimoto′s thyroiditis patients with thyroid nodules, ROC curve analysis showed that the AUC,sensitivity and specificity were 0.712,45.0% and 97.5% under serum Cla-1 detection, 0.738,85.0% and 57.5% under Gal-1 detection, and were 0.884,82.5% and 80.0% under Cla-1 combined with Gal-1 detection respectively, indicating the diagnostic efficacy of Cla-1 combined with Gal-1 was significantly better than that of single detection(P<0.05).Conclusion Ultrasound has a high detection rate for Hashimoto′s thyroiditis combined with thyroid nodules, but is not accurate in differentiating benign from malignant nodules, while patients with malignant nodules have elevated levels of CLA-1 and Gal-1,and the two indicators yield high sensitivity and specificity, and the combined detection of the two has good diagnostic efficacy.