超声弹性成像联合血清TSH、TK1、LMTK3对甲状腺乳头状癌的诊断价值及与肿瘤侵袭和增殖的关系研究

Diagnostic Value of Ultrasonic Elastography Combined with Serum TSH,TK1 and LMTK3 in Papillary Thyroid Carcinoma and Its Relationship Study with Tumor Invasion and Proliferation

目的:探讨超声弹性成像(UE)联合血清促甲状腺激素(TSH)、胸苷激酶1(TK1)、Lemur-酪氨酸激酶3(LMTK3)对甲状腺乳头状癌(PTC)的诊断价值及与肿瘤侵袭和增殖的关系。方法:选取2020年1月-2022年12月海军军医大学第二附属医院收治的91例PTC患者作为观察组。另选取本院同期90例甲状腺良性肿瘤患者作为对照组。对所有患者开展UE检查,对比两组UE参数,同时检测并对比两组血清TSH、TK1、LMTK3水平以及组织标本中侵袭基因、增殖基因的信使核糖核酸(m RNA)表达水平。Pearson法分析UE参数、血清TSH、TK1、LMTK3与侵袭基因、增殖基因m RNA表达水平的相关性。受试者工作特征(ROC)曲线分析UE联合血清TSH、TK1、LMTK3对PTC的诊断效能。结果:观察组超声弹性评分(ES)、弹性系数(SR)均高于对照组(均P<0.05)。观察组血清TSH、TK1、LMTK3水平均高于对照组(均P<0.05)。观察组去整合素-金属蛋白酶9(ADAM-9)、BCL6共抑制因子样蛋白1(BCORL1)、Xklp2靶蛋白(TPX2)及Twist1 m RNA表达水平均高于对照组(均P<0.05)。Pearson法分析结果显示,ES、SR及血清TSH、TK1、LMTK3均和ADAM9、BCORL1、TPX2、Twist1 m RNA表达水平均呈正相关(均P<0.05)。ES、SR及血清TSH、TK1、LMTK3联合检测对PTC诊断的灵敏度为91.52%,特异度为87.34%,曲线下面积(AUC)为0.894,联合诊断的效能均优于上述五项指标单独检测。结论:UE联合血清TSH、TK1、LMTK3对PTC具有较高的诊断价值。上述指标异常升高与PTC肿瘤侵袭、增殖有关。

Objective:To investigate the diagnostic value of ultrasonic elastography(UE)combined with serum thyroid-stimulating hormone(TSH),thymidine kinase 1(TK1)and Lemur-tyrosine kinase 3(LMTK3)in papillary thyroid carcinoma(PTC)and its relationship with tumor invasion and proliferation.Methods:91 patients with PTC who were admitted to The Second Affiliated Hospital of the Naval Military Medical University from January 2020 to December 2022 were selected as the observation group.In addition,90 patients with thyroid benign tumor in our hospital during the same period were selected as control group.UE examination was carried out in all patients,and UE parameters were compared in the two groups,and serum TSH,TK1,LMTK3 levels,invasive genes and proliferative genes messenger ribonucleic acid(mRNA)expression levels in tissue samples were detected and compared in the two groups.Pearson method was performed to determine the correlation between UE parameters,serum TSH,TK1,LMTK3 and mRNA expression levels of invasion genes and proliferation genes.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of UE combined with serum TSH,TK1 and LMTK3 for PTC.Results:The ultrasonic elastic score(ES)and elastic coefficient(SR)in the observation group were higher than those in the control group(all P<0.05).The levels of serum TSH,TK1 and LMTK3 in the observation group were higher than those in the control group(all P<0.05).The desintegrin-metalloproteinase 9(ADAM-9),BCL6 corepressor like protein 1(BCORL1),Xklp2 target protein(TPX2)and Twist1 mRNA expression levels in the observation group were higher than those in the control group(all P<0.05).Pearson method showed that ES,SR and serum TSH,TK1 and LMTK3 mRNA expression levels were positively correlated with those of ADAM9,BCORL1,TPX2 and Twist1(all P<0.05).The sensitivity,specificity and area under curve(AUC)of the combined detection of ES,SR,and serum TSH,TK1,and LMTK3 in the diagnosis of PTC were 91.52%,87.34%,and 0.894,respectively.The efficacy of the combined diagnosis was superior to the single detection of the above five indexes.Conclusion:UE combined with serum TSH,TK1 and LMTK3 has high diagnostic value for PTC,The abnormal elevation of these indexes is related to tumor invasion and proliferation of PTC.