MSCT特征及血清GPX3、TIMP-2、FGFR-4与甲状腺癌TNM分级的相关性

Correlation of MSCT characteristics and serum GPX3,TIMP-2,FGFR-4 with TNM grade of thyroid cancer

目的研究多层螺旋CT(MSCT)特征及血清谷胱甘肽过氧化物酶3(GPX3)、金属蛋白酶组织抑制剂-2(TIMP-2)、成纤维生长因子受体4(FGFR-4)与甲状腺癌TNM分级的相关性。方法回顾性选择2018年1月至2020年12月于马鞍山十七冶医院诊治的甲状腺癌患者46例纳入实验组,其中Ⅰ+Ⅱ期27例,Ⅲ+Ⅳ期19例,同期于本院就诊的良性甲状腺良性结节患者46例纳入对照组。两组均行MSCT及血清GPX3、TIMP-2、FGFR-4诊断。观察两组MSCT特征,血清GPX3、TIMP-2、FGFR-4水平。观察实验组不同TNM分级患者MSCT特征,血清GPX3、TIMP-2、FGFR-4水平。分析甲状腺癌患者MSCT特征及血清GPX3、TIMP-2、FGFR-4水平与不同TNM分级的相关性。结果实验组病灶形态不规则比例、边缘不清晰比例、实性及囊实性比例、不均匀强化比例、砂砾样钙化比例及病灶数目多发比例分别为73.91%、82.61%、39.13%、76.09%、56.52%、84.78%,均大于对照组(8.70%、15.22%、4.35%、36.96%、6.52%、17.39%),差异均有统计学意义(P<0.05);两组病灶直径≥5 mm比例比较,差异无统计学意义(P>0.05)。实验组血清GPX3、FGFR-4水平分别为(226.96±26.17)μg/L、(31.28±3.45)ng/mL,均高于对照组[(82.85±8.53)μg/L、(22.64±2.55)ng/mL],TIMP-2水平为0.43±0.06,低于对照组(0.75±0.08),差异均有统计学意义(P<0.05)。Ⅰ+Ⅱ期患者病灶形态不规则比例、边缘不清晰比例、实性及囊实性比例、不均匀强化比例、砂砾样钙化比例及病灶数目多发比例均大于Ⅰ+Ⅱ期患者,差异均有统计学意义(P<0.05);Ⅰ+Ⅱ期、Ⅲ+Ⅳ期患者病灶直径≥5 mm比例比较,差异无统计学意义(P>0.05)。Ⅲ+Ⅳ期患者血清GPX3、FGFR-4水平均高于Ⅰ+Ⅱ期患者,TIMP-2水平低于Ⅰ+Ⅱ期患者,差异均有统计学意义(P<0.05)。经Pearson相关分析,病灶形态不规则、边缘不清晰、实性及囊实性、不均匀强化、砂砾样钙化、病灶数目及血清GPX3、FGFR-4水平与甲状腺癌患者TNM分级均呈正相关(P<0.05),血清TIMP-2水平与甲状腺癌患者TNM分级呈负相关(P<0.05);病灶直径≥5 mm与甲状腺癌患者TNM分级不相关(P>0.05)。结论甲状腺癌存在多种典型的MSCT特征及血清GPX3、TIMP-2、FGFR-4水平异常改变,且甲状腺癌病灶多种MSCT特征及血清GPX3、FGFR-4、TIMP-2水平与TNM分级显著相关。

Objective To investigate the correlation between the characteristics of multi-slice spiral CT(MSCT)and serum glutathione peroxidase 3(GPX3),tissue inhibitor of metalloproteinase 2(TIMP-2),fibroblast growth factor receptor 4(FGFR-4)and TNM grade of thyroid cancer.Methods Forty-six thyroid cancer patients diagnosed and treated in Ma'anshan Seventeenth Metallurgical Hospital from January 2018 to December 2020 were retrospectively included in the experimental group,Among them,27 cases were in gradeⅠ+Ⅱ,and 19 cases were in gradeⅢ+Ⅳ,and 46 patients with benign thyroid nodules in our hospital during the same period were included in the control group.The two groups were diagnosed with MSCT and serum GPX3,TIMP-2 and FGFR-4.The MSCT characteristics,serum GPX3,TIMP-2 and FGFR-4 levels of the two groups were observed.The MSCT characteristics,serum GPX3,TIMP-2 and FGFR-4 levels of patients with different TNM grade in the experimental group were observed.The correlation between the characteristics of MSCT and serum levels of GPX3,TIMP-2,FGFR-4 and different TNM grade in thyroid cancer patients was analyzed.Results The proportion of irregular shape,the proportion of unclear edge,the proportion of solid and cystic consolidation,the proportion of uneven enhancement,the proportion of gravel calcification and the proportion of multiple lesions in the experimental group were 73.91%,82.61%,39.13%,76.09%,56.52%,84.78%,respectively,which were higher than those in the control group(8.70%,15.22%,4.35%,36.96%,6.52%,17.39%),the differences were statistically significant(P<0.05).There was no statistically significant difference in the proportion of lesion diameter≥5 mm between the two groups(P>0.05).The levels of GPX3 and FGFR-4 in the experimental group were(226.96±26.17)μg/L,(31.28±3.45)ng/mL,respectively,which were higher than those in the control group[(82.85±8.53)μg/L,(22.64±2.55)ng/mL],while the level of TIMP-2 was 0.43±0.06,which was lower than that in the control group(0.75±0.08),the differences were statistically significant(P<0.05).The proportion of irregular lesion shape,the proportion of unclear edge,the proportion of solid and cystic consolidation,the proportion of uneven enhancement,the proportion of gravel calcification and the proportion of multiple lesions in the gradeⅢ+Ⅳpatients were higher than those in the gradeⅠ+Ⅱpatients,the differences were statistically significant(P<0.05).There was no statistically significant difference in the proportion of lesion diameter≥5 mm in gradeⅠ+Ⅱand gradeⅢ+Ⅳpatients(P>0.05).The levels of GPX3 and FGFR-4 in gradeⅢ+Ⅳpatients were higher than those in gradeⅠ+Ⅱpatients,and the level of TIMP-2 was lower than that in gradeⅠ+Ⅱpatients,the differences were statistically significant(P<0.05).According to Pearson correlation analysis,lesions with irregular shape,unclear edges,solid and cystic consolidation,uneven enhancement,gravel calcification,number of lesions and serum GPX3 and FGFR-4 levels were positively correlated with TNM grading of thyroid cancer patients,while serum TIMP-2 level was negatively correlated with TNM grading of thyroid cancer patients(P<0.05).Lesion diameter≥5 mm was not correlated with TNM grading in thyroid cancer patients(P>0.05).Conclusion Thyroid cancer has multiple typical MSCT features and abnormal changes in serum GPX3,TIMP-2,and FGFR-4 levels.Moreover,multiple MSCT features of thyroid cancer lesions and serum GPX3,FGFR-4,and TIMP-2 levels are significantly correlated with TNM grading.