甲状腺乳头状癌超声特征及联合血清SIRT1对淋巴结转移的预测价值

Ultrasound characteristics of lymph node metastasis in papillary thyroid carcinoma and its predictive value in combination with serum SIRT1

目的探讨分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)超声特征及其联合血清沉默信息调控子1(silent mating-type information regulation2 homolog1,SIRT1)对淋巴结转移(lymph node metastasis,LNM)的预测价值。方法选取2022年5月至2023年5月商丘市第一人民医院超声科检查的90例PTC患者,根据患者超声检查是否存在淋巴结肿大、低回声、边界不清晰、微钙化等情况,将患者分为LNM组(26例)和无LNM组(64例)取其血清样本,采用酶联免疫吸附试验双抗体夹心法检测血清SIRT1水平。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析超声特征和血清SIRT1对PTC患者LNM的预测价值。结果与无LNM组比较,LNM组肿瘤多发病灶(P=0.001)、肿瘤直径≥1 cm(P=0.018)、低回声(P=0.005)、边界不清晰(P=0.001)、微钙化(P=0.0201)患者比例更高。LNM组血清SIRT1水平为(5.12±1.24)ng/mL,较无LNM组的(8.76±1.35)ng/mL更低(P<0.001)。ROC结果显示,血清SIRT1最佳截断值为7.59 ng/mL时,曲线下面积(area under the curve,AUC)为0.78(95%CI:0.746~0.835);此时敏感度和特异度分别为79.43%、71.56%。肿瘤数目多发、肿瘤直径≥1 cm、边界不清晰、微钙化、血清SIRT1<7.59 ng/mL对评估PTC LNM具有较好临床价值,联合检测预测价值更高,此时敏感度高达84.57%。多因素分析,结果显示肿瘤边界不清晰(OR=2.812,95%CI:1.220~6.482)、微钙化(OR=4.145,95%CI:1.335~12.870)、血清SIRT1降低(OR=2.399,95%CI:1.580~3.642)是影响PTC LNM的独立危险因素(P<0.05)。结论PTC LNM超声呈现边界不清晰、微钙化特征,且其血清SIRT1降低,超声特征与血清SIRT1联合检测对预测LNM具有较好预测价值。

ObjectiveTo investigate the ultrasonic characteristics of lymph node metastasis of papillary thyroid carcinoma and the predictive value of silent mating-type information regulation2 homolog1(SIRT1).Methods90 PTC patients admitted from May.2022 to May.2023 were selected.According to the ultrasonography of patients with lymph node enlargement,hypoecho,unclear boundary,microcalcification and other conditions,the patients were divided into 26 cases in the LNM group and 64 cases without LNM.All patients underwent thyroid ultrasonography,and their serum samples were collected.Serum SIRT1 levels were detected by enzyme-linked immunosorbent assay(ELISA)double-antibody sandwich method.ROC was used to analyze the predictive value of ultrasonic characteristics and serum SIRT1 for LNM in PTC patients.ResultsCompared with the group without lymph node metastasis,the proportion of patients with multiple tumor lesions(P=0.001),tumor diameter≥1 cm,hypoecho,unclear boundary and microcalcification was higher in the group with lymph node metastasis(P<0.05).The serum SIRT1 level of LNM group(5.12±1.24)ng/mL was lower than that of(8.76±1.35)ng/mL in the other group(P<0.05).ROC results showed that when the optimal cut-off value of serum SIRT1 was 7.59 ng/mL,the area under the curve was 0.78(95%CI:0.746-0.835).The sensitivity and specificity were 79.43%and 71.56%,respectively.Multiple tumors,tumor diameter≥1 cm(P=0.018),unclear boundaries(P=0.005),microcalcification(P=0.001),and serum SIRT1<7.59 ng/mL(P<0.001)had good clinical value in the evaluation of lymph node metastasis of papillary thyroid carcinoma,and the combined detection had a higher predictive value,with a sensitivity of 84.57%.Multivariate analysis showed that tumor boundaries were unclear(OR=2.812,95%CI:1.220-6.482),microcalcification(OR=4.145,95%CI:1.335-12.870),and serum SIRT1 decreased(OR=2.399,95%CI:1.580-3.642)were independent risk factors for lymph node metastasis of papillary thyroid carcinoma(P<0.05).ConclusionsLymph node metastasis of papillary thyroid carcinoma is characterized by unclear boundary and micro-calcification on ultrasound,and serum SIRT1 is decreased.The combined detection of ultrasound features and serum SIRT1 has a good predictive value in predicting lymph node metastasis in patients with papillary thyroid cancer.