超声及血清CK-19、Galectin-3、miRNA-363联合诊断PTMC颈部淋巴结转移的临床价值

Clinical value of ultrasonography combined with serum CK-19,Galectin-3,miRNA-363 in the diagnosis of cervical lymph node metastasis of PTMC

目的 研究超声及血清细胞角蛋白19(CK-19)、半乳糖凝集素3(Galectin-3)及微小核糖核酸-363(miRNA-363)联合诊断甲状腺微小乳头状癌(PTMC)颈部淋巴结转移(CLNM)的临床价值。方法 回顾性选取2021年7月至2023年6月在天津市环湖医院诊断的PTMC患者92例纳入研究组,选择同期本院收治的结节性微小甲状腺肿患者92例纳入对照组。观察两组病灶情况及超声特点;比较两组血清CK-19、Galectin-3、miRNA-363水平,研究组是否发生CLNM患者病灶超声特点及血清CK-19、Galectin-3、miRNA-363水平。分析PTMC~CLNM超声特点与血清CK-19、Galectin-3、miRNA-363水平的相关性。结果 研究组多枚病灶、病灶>0.5 mm、病灶纵横比≥1、病灶形态不规则、病灶边缘模糊、病灶微钙化、病灶低回声、淋巴结肿大占比分别为70.65%、71.74%、82.61%、61.96%、72.83%、80.43%、84.78%、70.65%,均大于对照组(31.52%、52.17%、27.17%、25.00%、19.57%、15.22%、66.30%、22.83%),差异均有统计学意义(P<0.05)。研究组血清CK-19、Galectin-3水平分别为(30.45±3.31)、(4.68±0.48)μg/L,均高于对照组[(7.05±0.73)、(1.72±0.19)μg/L],血清miRNA-363水平为(2.89±0.30) fmol/L,低于对照组[(4.30±0.46) fmol/L],差异均有统计学意义(P<0.05)。研究组发生CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、病灶微钙化、淋巴结肿大占比分别为90.91%、86.36%、95.45%、100.00%、90.91%,均大于未发生CLNM患者(64.29%、54.29%、0、25.00%、64.29%),差异均有统计学意义(P<0.05)。研究组发生CLNM患者血清CK-19、Galectin-3水平(41.20±4.42)、(5.94±0.62)μg/L,均高于未发生CLNM患者[(24.36±2.71)、(3.25±0.34)μg/L],血清miRNA-363水平为(2.14±0.23) fmol/L,低于未发生CLNM患者[(3.46±0.36) fmol/L],差异均有统计学意义(P<0.05)。经Pearson相关分析,CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、淋巴结肿大及血清CK-19、Galectin-3、miRNA-363水平均与CLNM呈正相关(P<0.05)。结论 超声及血清CK-19、Galectin-3、miRNA-363联合诊断PTMC~CLNM具有较高的临床价值。

Objective To investigate the clinical value of ultrasonography combined with serum cytokeratin 19(CK-19),Galectin-3(Galectin-3) and microRNA-363(miRNA-363) in the diagnosis of cervical lymph node metastasis(CLNM) in papillary thyroid microcarcinoma(PTMC).Methods A total of 92 patients with PTMC diagnosed in Tianjin Huanhu Hospital from July 2021 to June 2023 were retrospectively included in the study group,and 92 patients with nodular microgoitre treated in our hospital during the same period were included in the control group.Both groups were diagnosed by ultrasound and serum CK-19,galectin3 and miRNA-363.The lesions and ultrasonic characteristics of the two groups were observed.Serum CK-19,Galectin-3,and miRNA-363 levels in the two groups were compared,whether CLNM patients in the study group had focal ultrasound characteristics and serum CK-19,Galectin-3,and miRNA-363 levels were compared.The correlation between the ultrasonic characteristics of PTMC-CLNM and serum levels of CK-19,Galectin-3 and miRNA-363 was analyzed.Results Multiple lesions,lesions >0.5 mm,aspect ratio≥1,irregular shape,blurred edge,microcalcification,hypoechosis,and lymph node enlargement in the study group were 70.65%,71.74%,82.61%,61.96%,72.83%,80.43%,84.78%,70.65%,which were higher than those in the control group(31.52%,52.17%,27.17%,25.00%,19.57%,15.22%,66.30%,22.83%),the differences were statistically significant(P<0.05).Serum CK-19 and Galectin-3 levels in the study group were(30.45±3.31),(4.68±0.48) μg/L,which were higher than those in the control group[(7.05±0.73),(1.72±0.19) μg/L],and the level of serum miRNA-363 was(2.89±0.30) fmol/L,which was lower than that in the control group[(4.30±0.46) fmol/L],the differences were statistically significant(P<0.05).In the study group,the proportions of multiple lesions,irregular lesion shape,blurred lesion edges,microcalcification,and lymph node enlargement in patients with CLNM were 90.91%,86.36%,95.45%,100.00%,90.91%,which were higher than those without CLNM(64.29%,54.29%,0,25.00%,64.29%),the differences were statistically significant(P<0.05).In the study group,the levels of serum CK-19 and Galectin-3 in patients with CLNM were(41.20±4.42),(5.94±0.62) μg/L,which were higher than those without CLNM[(24.36±2.71),(3.25±0.34) μg/L],and the level of serum miRNA-363 was(2.14±0.23) fmol/L,which was lower than that without CLNM[(3.46±0.36) fmol/L],the differences were statistically significant(P<0.05).According to Pearson correlation analysis,CLNM patients had positive correlation with multiple lesions,irregular lesion morphology,blurred lesion edges,lymph node enlargement,and serum CK-19,Galectin-3,miRNA-363 levels(P<0.05).Conclusion Ultrasonography combined with serum CK-19,Galectin-3,miRNA-363 has high clinical value in the diagnosis of PTMC-CLNM.