高频超声联合TSH与Tg比值在鉴别甲状腺结节良恶性病变中的价值

Value of High Frequency Ultrasound Combined with TSH/Tg Ratio in Differentiating Benign and Malignant of Thyroid Nodules

目的分析高频超声联合促甲状腺素(TSH)与甲状腺球蛋白(Tg)比值在鉴别甲状腺结节良恶性病变中的价值。方法选择2020年1月至2020年12月西华县人民医院收治的132例甲状腺结节手术患者,所有患者均接受高频超声诊断,并采用免疫分析法检测TSH与Tg水平,计算TSH/Tg。以术后病理结果为金标准,根据良恶性分组,比较良性组、恶性组的高频超声诊断评分、TSH与Tg比值,并分析两者单独及联合的诊断效能;Pearson相关性检验TI-RADS评分与TSH/Tg的关系;绘制ROC图像分析高频超声联合TSH/Tg对甲状腺结节良恶性病变的预测价值。结果132例甲状腺结节患者经病理组织检查确诊为恶性的有24例[18.18%(24/132)],其中髓样癌10例[41.67%(10/24)],滤泡状癌9例[37.50%(9/24)],B型淋巴瘤5例[20.83%(5/24)];良性的有108例[81.82%(108/132)],其中甲状腺结节肿53例[49.07%(53/108)],腺瘤样甲状腺肿34例[31.48%(34/108)],腺瘤21例[19.44%(21/108)]。恶性组TI-RADS分类评分及TSH/Tg均高于良性组,差异有统计学意义(P<0.05)。Pearson相关性发现,甲状腺肿瘤患者的血清TSH/Tg与TI-RADS分类评分呈正相关,差异有统计学意义(r>0,P<0.05)。TI-RADS评分、TSH/Tg及联合诊断与金标准的一致性(Kappa)分别为0.624、0.524、0.901。TSH/Tg、TI-RADS分类评分及联合诊断的准确度、灵敏度比较,联合诊断最高,差异有统计学意义(P<0.05)。ROC曲线结果发现,TSH/Tg、TI-RADS分类评分及联合预测甲状腺结节良恶性的AUC为0.801(95%CI:0.717~0.886)、0.756(95%CI:0.664~0.848)、0.895(95%CI:0.832~0.958)。结论高频超声联合TSH与Tg比值在鉴别甲状腺结节良恶性病变中具有一定价值,通过联合诊断可提高诊断效能,值得应用。

Objective To analyze the value of high-frequency ultrasound combined with the ratio of thyrotropin(TSH)to thyroglobulin(Tg)in differentiating benign and malignant of thyroid nodules.Methods A total of 132 cases of thyroid nodule surgery patients admitted to our hospital from January 2020 to December 2020 were selected.All patients were diagnosed by highfrequency ultrasound,and the levels of TSH and Tg were detected by immunoassay to calculate TSH/Tg.Taking the postoperative pathological results as the gold standard,according to the benign and malignant groups,the high-frequency ultrasound diagnostic score and TSH/TG ratio of benign and malignant groups were compared,and the diagnostic efficacy of the two groups alone and in combination was analyzed.Pearson correlation test was used to test the relationship between TI-RADS score and TSH/Tg.Draw ROC image to analyze the predictive value of high frequency ultrasound combined with TSH/Tg in benign and malignant thyroid nodules.Results Of the 132 patients with thyroid nodules,24(18.18%)were diagnosed as malignant by pathological examination,including 10 cases of medullary carcinoma[41.67%(10/24)],9 cases of follicular carcinoma[37.50%(9/240]and 5 cases of type B lymphoma[20.83%(5/24)],108 cases[81.82%(108/132)],were benign,including 53 cases[49.07%(53/108)].with thyroid nodular goiter,34 cases[31.48%(34/108)],with adenomatous goiter and 21 cases[19.44%(21/108)],with adenoma.TI-RADS classification score and TSH/Tg in malignant group were higher than those in benign group,and the difference was statistically significant(P<0.05).Pearson correlation showed that TSH/Tg in serum of patients with thyroid tumor was positively correlated with TI-RADS classification score,and the difference was statistically significant(r>0,P<0.05).TI-RADS score,TSH/Tg and Kappa of combined diagnosis with gold standard were 0.624,0.524 and 0.901,respectively.Compared with TSH/Tg,TI-RADS classification scores and the accuracy and sensitivity of combined diagnosis,the combined diagnosis was the highest,and the difference was statistically significant(P<0.05).The ROC curve showed that the AUC of TSH/Tg,TI-RADS classification score and joint prediction of thyroid nodules were 0.801(95%CI:0.717-0.886),0.756(95%CI:0.664-0.848)and 0.895(95%CI:0.832-0.958).Conclusion High-frequency ultrasound combined with the ratio of TSH to Tg has certain value in differentiating benign and malignant thyroid nodules.Combined diagnosis can improve the diagnostic efficiency and is worth popularizing.