中国癌症杂志 ›› 2017, Vol. 27 ›› Issue (12): 953-958.doi: 10.19401/j.cnki.1007-3639.2017.12.006

• 论著 • 上一篇    下一篇

首次131I治疗前刺激性甲状腺球蛋白在预测颈部及远处转移性分化型甲状腺癌的意义

陈 鹏,宋长祥,陆 武,刘 永,杜 鹏   

  1. 徐州医科大学附属连云港医院,连云港市第一人民医院核医学科,江苏 连云港 222002
  • 出版日期:2017-12-30 发布日期:2018-01-11
  • 通信作者: 宋长祥 E-mail:wangfang19820808@163.com
  • 基金资助:
    连云港市卫生计生科技项目(201610)。

The significance of stimulated thyroglobulin in predicting neck and distant metastasis in postoperative patients with differentiated thyroid carcinoma before the first 131I ablation therapy

CHEN Peng, SONG Changxiang, LU Wu, LIU Yong, DU Peng   

  1. Department of Nuclear Medicine, the First People's Hospital of Lianyungang, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222002, Jiangsu Province, China
  • Published:2017-12-30 Online:2018-01-11
  • Contact: SONG Changxiang E-mail: wangfang19820808@163.com

摘要: 背景与目的:由于受到残余甲状腺等多种因素的影响,刺激性甲状腺球蛋白(stimulated thyroglobulin,sTg)在首次131I治疗前对分化型甲状腺癌(differentiated thyroid carcinoma,DTC)复发转移的诊断价值尚有争议。该研究旨在探讨sTg在首次131I治疗前预测DTC患者颈部及远处转移的意义。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天测sTg水平,131I治疗后5~7 d行131I全身显像和SPECT/CT断层融合显像。根据是否存在转移,将所有患者分为无转移组(M0)和颈部淋巴结转移组(M1)和远处转移组(M2),比较组间sTg值差异有无统计学意义,并通过ROC曲线及最佳诊断界值点(diagnostic critical point,DCP)评估sTg值预测转移的价值。结果:M0组、M1组和M2组的sTg值的四分位数间距分别为0.47~9.57、12.34~50.86和69.47~462.00 ng/mL。M1组、M2组与M0组的sTg相比差异均有统计学意义(P<0.01和P<0.01)。sTg值的ROC曲线下面积分别为0.872、0.964,DCP分别为23.95和20.93 ng/mL,灵敏度、特异度、准确度分别为68.42%、100%、92.31%和85.71%、100%、95.40%。结论:首次131I治疗前检测sTg值对DTC转移有重要的预测价值,对远处转移的预测价值更大。

关键词: 分化型甲状腺癌, 甲状腺球蛋白, 放射性碘治疗

Abstract: Background and purpose: It was controversial that value of the first pre-ablation stimulated thyroglobulin (sTg) in the diagnosis of recurrence or metastasis of differentiated thyroid carcinoma (DTC), due to the influence of many factors such as residual thyroid. In this study, we investigated the significance of the first pre-ablation sTg in predicting neck and distant metastasis in postoperative patients with DTC. Methods: The study included 106 patients with DTC who had undergone total thyroidectomy and lymphadenectomy. The pre-ablation sTg of 106 patients was measured one day before the first 131I ablation therapy, and the patients underwent 131I whole-body imaging and SPECT/CT fusion imaging 5-7 days after 131I ablation therapy. Patients were divided into 3 groups as M0 group, M1 group and M2 group according to the presence and absence of metastases, respectively. The sTg values between groups were compared by Mann-Whitney rank-sum test. The ROC curves and diagnostic critical point (DCP) were analyzed to evaluate the predictive value of sTg. Results: The pre-ablation sTg of M1 group and M2 group were significantly higher than that of M0 group (U=143.00, P<0.01; U=60.00, P<0.01). Areas under the ROC curve for sTg were 0.872 and 0.964, respectively. The cut-off values of DCP of sTg were 23.95 ng/mL with a sensitivity of 68.42%, specificity of 100%, accuracy of 92.31%, and 20.93 ng/mL with a sensitivity of 85.71%, specificity of 100%, accuracy of 95.40%, respectively. Conclusion: The pre-ablation sTg value may be a useful diagnostic marker for predicting metastasis before the first 131I ablation therapy, especially for the prediction of distant metastasis.

Key words: Differentiated thyroid carcinoma, Thyroglobulin, Radioiodine therapy