分化型甲状腺癌术后首次131I治疗前刺激性Tg水平与转移灶的关系

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摘要目的：探讨刺激性甲状腺球蛋白（Stimulated thyroglobulin，sTg）、sTg/促甲状腺激素（Thyrotropin，TSH）比值在分化型甲状腺癌（Differentiated thyroid carcinoma，DTC）术后首次131I治疗前对转移的预测价值。方法：106例行甲状腺全切术及颈淋巴结清扫术的DTC患者，首次131I治疗前1 d测sTg、TSH水平，131I治疗后5～7 d行131I-SPECT/CT显像。根据是否存在转移，将所有病例分为无转移组（M0）和转移组（M1），比较两组间sTg、sTg/TSH比值有无差异，并通过ROC曲线及最佳诊断界值点（Diagnostic critical point，DCP）评估sTg、sTg/TSH比值预测转移的价值。结果：M0和M1组的sTg范围分别为0.47～9.57 ng/mL和27.10～462.00 ng/mL，2组的Tg/TSH比值则分别为0.00～0.09 ng/U和0.29～4.78 ng/U。2组间的sTg、Tg/TSH相比均有统计学意义（Mann-Whitney秩和检验：Tg：P=0.000（U=242.50）；Tg/TSh：P=0.000（U=237.50）。sTg、sTg/TSH比值的ROC曲线下面积分别为0.913、0.914，DCP分别为40.60 ng/mL、0.24 ng/U，灵敏度、特异度、准确度分别为70.21%、100%、86.79%和80.85%、94.92%、88.68%。结论：首次131I治疗前检测sTg、sTg/TSH比值对预测甲状腺癌转移有重要的意义。

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	刘永
	陈鹏

关键词 ：甲状腺肿瘤；体层摄影术, 发射型计算机, 单光子；碘

Abstract：Objective: To investigate the relationship between first pre-ablation stimulated thyroglobulin(sTg) and sTg/thyrotropin(TSH) levels and metastasis in postoperative patients with differentiated thyroid carcinoma(DTC). Methods: The study included 106 patients with DTC who had undergone total thyroidectomy and lymphadenectomy. The pre-ablation sTg and TSH of 106 patients were measured one day before first 131I ablation therapy, and the patients undergone 131I-SPECT/CT on 5～7 days after 131I ablation therapy. Patients were divided into two groups as M0 group and M1 group according to the presence and absence of metastases, respectively. The sTg and sTg/TSH value between M0 and M1 were compared by Mann-Whitney rank-sun test. The ROC curves and diagnostic critical point(DCP) were analyzed to evaluate the predictive values of sTg and sTg/TSH. Results: The pre-ablation sTg and sTg/TSH of M1 were significantly higher than those of M0(U=242.50, P=0.000; U=237.50, P=0.000). Areas under the ROC curve for sTg and sTg/TSH was 0.913 and 0.914. The cut-off values of DCP of sTg and sTg/TSH were 40.60 ng/mL with a sensitivity of 70.21%, specificity of 100%, accuracy of 86.79%, and 0.24 ng/U with a sensitivity, of 80.85%, specificity of 84.92%, accuracy of 88.68%. Conclusion: The pre-ablation sTg and sTg/TSH may be a useful diagnostic marker for predicting metastases before the first 131I ablation therapy.

Key words： Thyroid neoplasms Tomography, emission-computed, single-photon Iodine

收稿日期: 2016-11-10

PACS:	Ｒ736.1
	Ｒ817.4

基金资助:连云港市卫生计生科技项目（201610）。

通讯作者: 陈鹏，连云港市第一人民医院核医学科，222002。E-mail：lanfeng20021493@163.com

作者简介: 刘永（1977-），男，江苏邳州人，副主任医师。E-mail：liuyongpz@126.com

引用本文:

刘永，陈鹏，宋长祥，陆武，杜鹏. 分化型甲状腺癌术后首次131I治疗前刺激性Tg水平与转移灶的关系[J]. 中国临床医学影像杂志, 2017, 28(7): 471-474.
LIU Yong, CHEN Peng, SONG Chang-xiang, LU Wu, DU Peng. The relationship between first pre-ablation sTg levels and metastasis in#br# postoperative patients with differentiated thyroid carcinoma. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(7): 471-474.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I7/471

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