穿刺洗脱液胸苷激酶TK1检测在甲状腺结节性质鉴别中的意义

发布时间：2019-06-09 17:33

【摘要】：目的通过检测TK1在离体及在体甲状腺结节穿刺洗脱液的表达在甲状腺良恶性结节的差异和临床特点的相关性的关系,分析TK1水平检测在甲状腺结节良恶性鉴别中及临床分期的意义。方法离体组选取天津医科大学总医院普通外科2016年5月-2016年12月间甲状腺手术标本,标本离体后细针穿刺结节103枚行TK1水平检测,术后石蜡病理证实甲状腺良性疾病的结节39个,恶性结节64个。并将术后石蜡病理证实为甲状腺乳头状癌着根据年龄、性别、结节大小、病灶数目、被膜情况,周围软组织,淋巴结转移数目、侧颈淋巴结情况进行分组并进行统计分析。在体组选取同时期在我院行甲状腺细针穿刺检查,穿刺病理证实良性或恶性(恶性及可疑恶性)结节42例,检测穿刺洗脱液TK1水平。结合临床资料,分析TK1在甲状腺良恶性结节中表达的差异。结果离体组穿刺洗脱液中甲状腺良性结节TK1平均浓度为(5.973±0.8779)pmol/L,恶性结节平均浓度为(8.852±0.5934)pmol/L,两者相比差异具有统计学意义。结节性甲状腺肿穿刺液TK1水平为(2.696±0.2054)pmol/L,甲状腺腺瘤为(11.22±1.462)pmol/L,二者之间的差异具有统计学意义,而研究中甲状腺腺瘤(11.22±1.462)pmol/L和甲状腺癌(8.852±0.5934)pmol/L,TK1水平比较则没有统计学意义。对结节性甲状腺肿和甲状腺癌结节进行统计发现以4.225pmol/L作为截断值,对于鉴别其性质的敏感度和特异度为95.83%和84.38%。ROC曲线下面积为0.941。在进行年龄、性别、结节大小、病灶数目、被膜情况组的TK1水平进行比较发现,差异没有统计学意义,而周围软组织,淋巴结转移数目、侧颈淋巴结组情况的TK1水平差异具有统计学意义,P值均小于0.001。在体组良性结节平均浓度为(3.72±0.26)pmol/L,恶性结节平均值为(7.67±0.33)pmol/L,p0.01,差异有统计学意义。在体良性结节穿刺洗脱液中TK1平均浓度为(3.72±0.26)pmol/L,恶性结节穿刺洗脱液中TK1平均值为(7.67±0.33)pmol/L,差异有统计学意义。以4.732 pmol/L作为截断值,计算曲线下面积为0.72,对于鉴别其性质的敏感度和特异度为75.61%和66.29%。结论穿刺洗脱液TK1水平测定有助于在除外增生性腺瘤的甲状腺结节性质鉴别,对于辅助甲状腺细针穿刺具有一定意义。穿刺洗脱液TK1水平测定有助于预测甲状腺癌侵袭性及临床分期,对于甲状腺乳头状癌的预后评估具有一定临床意义。
[Abstract]:Objective to detect the relationship between the expression of TK1 in thyroid nodules in vitro and in vivo and the clinical characteristics of benign and malignant thyroid nodules. To analyze the significance of TK1 level in the differential diagnosis and clinical stage of benign and malignant thyroid nodules. Methods the thyroid gland specimens from May 2016 to December 2016 were selected from the general surgery department of Tianjin Medical University General Hospital. The level of TK1 was detected by fine needle puncture nodules in vitro. 39 nodules and 64 malignant nodules in benign thyroid diseases were confirmed by paraffin pathology after operation. According to age, sex, nodular size, lesion number, capsule condition, surrounding soft tissue, number of lymph node metastasis and lateral cervical lymph node, the patients with papilla thyroid carcinoma were divided into two groups according to age, sex, nodular size, number of lesions, capsule condition, surrounding soft tissue, number of lymph node metastasis and lateral cervical lymph node. In the body group, thyroid fine needle puncture was performed in our hospital at the same time. 42 cases of benign or malignant (malignant and suspected malignant) nodules were confirmed by puncture pathology, and the TK1 level of puncture eluent was detected. Combined with clinical data, the difference of TK1 expression in benign and malignant thyroid nodules was analyzed. Results the average concentration of TK1 in benign thyroid nodules in vitro group was (5.973 卤0.8779) pmol/L, and the average concentration of malignant nodules was (8.852 卤0.5934) pmol/L,. There was significant difference between the two groups. The TK1 level of nodular goiter puncture fluid was (2.696 卤0.2054) pmol/L, and that of thyroid adenoma was (11.22 卤1.462) pmol/L, there was significant difference between the two groups. However, there was no significant difference between thyroid adenoma (11.22 卤1.462) pmol/L and thyroid carcinoma (8.852 卤0.5934) pmol/L,TK1. It was found that the sensitivity and specificity of 4.225pmol/L as cut-off value for distinguishing the properties of nodular goiter and thyroid carcinoma nodules were 95.83% and the area under 84.38%.ROC curve was 0.941. There was no significant difference in TK1 level between age, sex, nodular size, lesion number and capsule condition group, but the number of surrounding soft tissue and lymph node metastasis was not statistically significant. There was significant difference in TK1 level between lateral cervical lymph node group and lateral cervical lymph node group, and the P value was less than 0.001%. The average concentration of benign nodules in vivo group was (3.72 卤0.26) pmol/L, and the average value of malignant nodules was (7.67 卤0.33) pmol/L,p0.01,. The average concentration of TK1 in the puncture eluent of benign nodules was (3.72 卤0.26) pmol/L, and the average concentration of TK1 in malignant nodules was (7.67 卤0.33) pmol/L,. Using 4.732 pmol/L as cut-off value, the area under the curve was 0.72, and the sensitivity and specificity for distinguishing its properties were 75.61% and 66.29%. Conclusion the determination of TK1 level in puncture eluent is helpful to distinguish the nature of thyroid nodules except hyperplastic adenoma and has certain significance for auxiliary thyroid fine needle puncture. The determination of TK1 level in puncture eluent is helpful to predict the invasiveness and clinical stage of thyroid carcinoma, and has certain clinical significance for the prognosis evaluation of thyroid papilla carcinoma.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581

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