甲状腺球蛋白在分化型甲状腺癌监测和预后判断中的意义

发布时间：2018-02-27 11:05

  本文关键词： 分化型甲状腺癌 甲状腺球蛋白 ~(131)I治疗　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：甲状腺球蛋白(thyroglobulin,Tg)是分化型甲状腺癌(differentiated thyroid cancer,DTC)术后、经~(131)I治疗后长期随访的重要指标,本研究旨在探索其在非远处转移性(non-metastatic,MO)DTC患者监测和预后判断中的意义,并进一步选取中低危患者动态评价其~(131)I治疗后短期转阴情况,分为以下两部分:第一部分治疗前刺激性甲状腺球蛋白10ng/ml的非远处转移性分化型甲状腺癌~(131)I治疗后的临床转归目的探讨治疗前刺激性甲状腺球蛋白(preablation stimulated Tg,ps-Tg)10ng/ml的非远处转移性DTC患者~(131)I治疗反应及其影响因素。方法纳入2007年3月至2014年8月在北京协和医院拟行~(131)I治疗的ps-Tg10ng/ml的非远处转移性DTC患者157例,根据2015年ATA指南中治疗反应评估体系分为ER组(n=49)、AR组(n=36)和IR组(包括BIR和SIR,n=72)3组,比较3组的临床特征和ps-Tg水平,比较IR与非IR组的ps-Tg水平,采用ROC曲线及最佳诊断界值点评估ps-Tg对IR的预测价值。结果3组在性别(χ2=6.82,P=0.033)、甲状腺腺外侵犯(H=31.380,P0.001)、颈部淋巴结转移(H=14.375,P=0.001)和ps-Tg水平(H=35.142,P0.001)方面差异有统计学意义。IR组的ps-Tg水平明显高于非IR组(U = 1384.5,P0.001),ER组与AR组间差异无统计学意义(U=771.5,P=0.326)。此类患者诊断IR的ps-Tg界值点为28.3ng/ml(灵敏度57.5%,特异性 87.1%),ROC 曲线下面积(AUC=0.774,95%CI:0.701～0.847)。结论 ps-Tg10ng/ml的非远处转移DTC患者中近半数经~(131)I治疗表现为IR。ps-Tg28.3ng/ml可作为提示不良预后的界值点。第二部分中低危分化型甲状腺癌经1311治疗后短期甲状腺球蛋白转阴情况的动态监测目的动态监测DTC患者~(131)I治疗后早期的血清学指标,探讨Tg转阴情况及其影响因素。方法纳入78例中低危DTC患者随访观察,于~(131)I治疗当天、治疗后4周内每周动态监测患者促甲状腺激素(thyroid stimulating hormone,TSH)、Tg、甲状腺球蛋白抗体(anti-thyroglobulin,TgAb),观察患者Tg转阴的动态规律。根据患者在观察期末Tg是否转阴分为G1组(Tg≤0.1ng/ml,n=35)和G2组(Tg0.1ng/ml,n=43)两组,测定患者1311治疗后残余甲状腺对放射性碘的摄取指数,进一步分析年龄、性别、TSH、残余甲状腺等因素与~(131)I治疗后1月末Tg转阴的关系。结果治疗当天,治疗后1、2、3、4周的人群总体血清Tg转阴率分别为3.8%、14.1%、21.8%、30.8%、44.9%。单因素分析结果显示,两组患者在年龄(F=3.478,P=0.032)和残余甲状腺指数(U=4.917,P=0.025)等方面差异有统计学意义。多因素Logistic回归分析结果显示,~(131)I治疗后早期Tg能否转阴与残余甲状腺(P=0.008)密切相关。结论近半数中低危DTC患者的血清Tg水平已于~(131)I治疗后4周转阴。Tg的转阴与患者术后甲状腺残余量密切相关。
[Abstract]:Thyroid globulin (TG) is an important index of long-term follow-up after differential thyroid cancer DTC. The purpose of this study was to explore its significance in monitoring and prognosis of non-metastatic non-metastatic MODTC patients. Furthermore, the patients with middle and low risk were selected to evaluate the short-term negative change after treatment. There are two parts as follows: the first part is the clinical outcome of 10 ng / ml stimulant thyroglobulin 10 ng / ml of non-distant metastatic thyroid carcinoma after treatment. Objective to investigate the non-distant effect of pre-treatment stimulating thyroglobulin precirculation stimulated Tgamps-Tgn 10ng / ml on the prognosis of non-distant metastatic thyroid carcinoma. Methods from March 2007 to August 2014, 157 patients with non-distant metastatic DTC who were scheduled to be treated with ps-Tg10ng/ml in Peking Union Hospital were included in this study. According to the treatment response assessment system in 2015 ATA guidelines, we divided the ER group into two groups, ER group (n = 36) and IR group (n = 3). The clinical features and ps-Tg levels of the three groups were compared, and the ps-Tg levels of IR and non-IR groups were compared. Results the predictive value of ps-Tg for IR was evaluated by ROC curve and the best diagnostic threshold. Results there were significant differences in sex (蠂 ~ 2 ~ 2 ~ (6.82) P ~ + ~ (0.033)), extraglandular invasion of thyroid gland (H ~ (31) 380m P ~ (0.001), cervical lymph node metastasis ~ (14.375) P ~ (0.001)) and ps-Tg level (H _ 35.142 P ~ (0.001)). There was significant difference in ps-Tg level of IR group. There was no significant difference between ER group and AR group compared with non-IR group (U = 1384.5) P0.001. There was no significant difference between ER group and AR group. The ps-Tg threshold for diagnosing IR in these patients was 28.3ng / ml (sensitivity 57.5, specificity 87.1C = 0.77495CIW 0.701T 0.8470.Conclusion nearly half of non-distant metastatic DTC patients with ps-Tg10ng/ml are diagnosed by AUC 0.77495 CIW 0.701a 0.8470.Conclusion nearly half of patients with non-distant metastatic DTC with ps-Tg10ng/ml are diagnosed with ROC by 28.3 ng / ml (sensitivity 57.5%, specificity 87.41%). Conclusion there is no significant difference between ER group and AR group. The clinical manifestation of IR.ps-Tg28.3ng/ml is that it can be used as a cutoff point for indicating poor prognosis. Part 2 dynamic monitoring of short-term thyroglobulin negative transition after 1311 treatment in patients with low and low risk differentiated thyroid carcinoma objective to dynamically monitor the change of thyroid globulin negative in patients with DTC after treatment with 131I. Early serological markers, Methods 78 patients with moderate and low risk DTC were followed up and observed on the day of treatment. After 4 weeks of treatment, the thyroid hormone thyroid stimulating hormoney TSH, thyroglobulin antibody anti-thyroglobulinTgAban, and the dynamic rule of TG negative conversion were observed. According to whether the TG turned negative at the end of the treatment, the patients were divided into G1 group (TG 鈮，

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