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1.
目的:评估甲状腺结节细针穿刺(fine?needle aspiration,FNA)细胞学检查联合BRAFV600E基因检测对直径≤5 mm、美国放射学会甲状腺超声影像数据报告系统(TI?RADS)评分为5的甲状腺微小结节良恶性的术前诊断价值及意义。方法:回顾性分析75例患者的96枚直径≤5 mm、TI?RADS 5的甲状腺微小结节术前FNA细胞学检查和BRAFV600E基因检测结果,以手术病理为金标准,分析FNA细胞学检查、BRAFV600E基因突变检测以及两者联合对甲状腺微小结节良恶性的诊断价值。结果:FNA细胞学检查联合BRAFV600E基因突变检测的敏感性、准确性、特异性、阳性预测值、阴性预测值分别为95.0%、93.8%、91.7%、95.0%、91.7%,受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.933。联合检测的敏感性、准确性和ROC曲线下面积均高于单一的FNA细胞学检查及BRAFV600E基因突变检测,差异有统计学意义(P<0.05)。结论:FNA细胞学检查联合BRAFV600E基因突变检测可以提高直径≤5 mm且评分为TI?RADS 5的甲状腺微小结节的术前诊断效能,减少漏诊的发生。同时对于直径≤5 mm的特殊位置以及多灶性的甲状腺微小结节,可以在提高穿刺准确性的基础上,帮助患者确定最佳的手术方案。  相似文献   

2.
目的 探讨甲状腺细针穿刺(fine needle aspiration,FNA)样本的BRAF V600E基因突变检测在甲状腺结节术前风险分层管理中的应用价值。 方法 收集甲状腺结节患者手术前经超声引导下细针穿刺(ultrasound guided fine needle aspiration,US-FNA)样本141例(155个结节),用实时荧光定量PCR(quantitative real-time PCR,Q-PCR)方法检测FNA样本的BRAF V600E突变情况,同时对US-FNA样本行液基细胞薄层制片、细胞病理学诊断;以术后病理诊断结果为金标准,比较FNA样本BRAF V600E突变检测与术后病理诊断的一致性,并分析FNA样本BRAF V600E突变检测和细胞学检查两种方法在甲状腺结节术前风险分层管理中的优劣。 结果 141例(155个结节)术前FNA样本BRAF V600E突变检测结果显示BRAF V600E突变阳性率为79.4%(123/155);与术后病理诊断结果比较,FNA样本BRAF V600E突变检测对甲状腺乳头状癌诊断敏感性87.9%、特异性100%、阳性预测值100%、阴性预测值45.2%、准确性89%。FNA细胞学检查对其诊断的敏感性87.9%、特异性78.6%、阳性预测值97.6%、阴性预测值39.3%、准确性87%。BRAF V600E突变检测联合FNA细胞学检查对甲状腺结节良恶性诊断的敏感性94.3%,与单一FNA样本BRAF V600E突变检测和细胞学检查方法的敏感性比较,差异具有统计学意义(P<0.05)。 结论 甲状腺FNA样本BRAF V600E突变检测联合细胞学检查可作为第一推荐纳入甲状腺结节风险分层管理措施中。  相似文献   

3.
刘颖  徐潮阳  马拥军 《浙江医学》2023,45(8):809-813
目的探讨超声引导下的细针穿刺(FNA)细胞学检查联合BRAFV600E基因检测在甲状腺癌诊断的临床价值。方法回顾2021年1至12月金华市中心医院诊断为甲状腺结节并选择手术治疗的121例患者临床资料,均接受超声引导下的甲状腺FNA检查和BRAFV600E基因检测;记录FNA、BRAFV600E基因检测和术后病理检查结果。分析甲状腺癌患者的临床病理特征以及FNA联合BRAFV600E基因突变检测对诊断甲状腺癌的临床价值。结果121例手术治疗的甲状腺结节患者有117例术后确诊为甲状腺乳头状癌,其中甲状腺微小乳头状癌(PTMC)105例(89.7%);甲状腺乳头状癌直径>1cm时,更易发生多发结节(P<0.05)。FNA联合BRAFV600E基因检测能提高PTC诊断的灵敏度(0.957比0.727,P<0.01)。结论FNA联合BRAFV600E基因检测能提高诊断PTC的灵敏度,但鉴于PTMC的高检出率,因此临床应用中应考虑是否存在过度诊断。  相似文献   

4.
目的 探讨BRAF V600E基因检测对超声高危、细胞学BethesdaⅠ类甲状腺结节良恶性的鉴别诊断价值,以及与BRAF V600E基因突变相关的临床超声特征。方法 回顾性分析郑州大学第一附属医院2018年3月至2019年6月经超声诊断为高危且细针穿刺判读为细胞学BethesdaⅠ类的甲状腺结节共780例,其中行BRAF V600E基因检测且有组织病理结果的共70例,将这些患者纳入研究。计算BRAF V600E基因检测在诊断超声高危、细胞学BethesdaⅠ类甲状腺结节的特异度、敏感度、阳性预测值、阴性预测值以及阳性率,构建受试者工作特征(ROC)曲线分析BRAF V600E基因检测对这类结节的诊断效能;应用χ2检验分析与BRAF V600E基因突变相关的临床超声特征。结果 BRAF V600E基因检测诊断超声高危、细胞学BethesdaⅠ类甲状腺结节的特异度为88.2%(15/17),敏感度为90.5%(48/53),阳性预测值为96.0%(48/50),阴性预测值为75.0%(15/20),阳性率为71.4%(50/70),曲线下面积为0.894。χ  相似文献   

5.
目的:探讨细针穿刺抽吸细胞学活检在甲状腺结节诊断中的应用价值。方法:选择甲状腺结节患者200例,均接受超声和甲状腺功能检查,采用细针穿刺抽吸细胞学活检(FNAC)和丝/苏氨酸特异性激酶基因V600E(BRAF V600E)突变分析,研究其应用价值。结果:FNAC检测与病理符合率为76.5%,BRAFV600E检测与病理符合率为87.0%,二者联合检测的敏感度为92.3%,特异性为97.6%。结论:FNAC与BRAF联合应用,其特异性、敏感性更高,建议联合应用。  相似文献   

6.
目的:探讨细针穿刺活检(fine needle aspiration biopsy,FNAB)联合BRAF?V600E基因检测对甲状腺可疑恶性结节良恶性的鉴别诊断价值。方法:回顾性分析经外科手术后获得常规病理结果的101个甲状腺结节,术前超声诊断为可疑恶性结节,并同时行FNAB及BRAF?V600E基因检测,以术后常规病理结果为金标准,评价两种不同方法单独和联合运用对甲状腺可疑恶性结节的诊断价值。结果:获得术后病理结果的100例患者101个甲状腺可疑恶性结节中,良性21例,恶性80例。BRAF?V600E基因突变型结节75个,其中FNAB诊断阳性结节70个,阴性结节5个。BRAF?V600E基因野生型结节26个,其中FNAB诊断阳性结节9个,阴性结节17个。FNAB对甲状腺可疑恶性结节的灵敏度及特异度分别为93.70%、80.95%,BRAF?V600E基因检测对甲状腺可疑恶性结节的灵敏度及特异度分别为92.50%、95.24%,FNAB联合BRAF?V600E基因检测对甲状腺可疑恶性结节的灵敏度及特异度分别为98.59%、100.00%。结论:FNAB联合BRAF?V600E基因检测能够提高对甲状腺可疑恶性结节良恶性鉴别诊断效能,尤其对甲状腺乳头状癌特异性更高,值得临床推广应用。  相似文献   

7.
目的 探讨甲状腺结节子宫球蛋白相关蛋白1(UGRP1)的表达与甲状腺结节性质、功能及BRAFV600E基因突变的关系.方法 153例甲状腺组织取自131例以甲状腺结节为主诉的患者,根据细针穿刺细胞学检查(US-FNAC)结果分为甲状腺结节组(47例)、桥本甲状腺炎组(38例)、甲状腺癌组(46例),正常甲状腺组(22例)取自良性结节旁正常甲状腺组织.通过免疫组化方法分析甲状腺细胞U GRP 1的表达,分析4组患者U GRP 1表达情况,U GRP 1阳性组和阴性组甲状腺功能、超声特征以及与BRAFV600E基因突变的关系.结果 桥本甲状腺炎、甲状腺结节和甲状腺癌组UGRP1阳性表达率分别为71.1%、4.3%和2.2%,正常甲状腺组织中U GRP 1表达阴性,差异有统计学意义(P<0.05).TT3、TT4、TSH在UGRP1阳性组和阴性组差异无统计学意义.UGRP1表达与BRAFV600E基因突变之间存在相关性(P=0.023,C=0.414).结论 甲状腺结节中,桥本甲状腺炎U GRP 1阳性高表达,U GRP 1可能作为区分桥本甲状腺炎与正常甲状腺和甲状腺癌的参考指标之一.  相似文献   

8.
《中国现代医生》2017,55(31):111-113,121,封3
目的探讨甲状腺结节细针穿刺细胞学检查及超声评估系统对术前良恶性甲状腺结节鉴别及诊断价值。方法对我院250例甲状腺结节患者的超声声像图资料,细针穿刺细胞学检查结果及其中同时采用手术病理学检查的41例患者病理学资料进行比较分析。结果与手术病理检查结果相比,细针穿刺细胞学检查结果的符合率为87.8%,诊断甲状腺癌的特异性为92.6%,敏感性为78.6%;超声评估系统诊断符合率为92.7%,诊断甲状腺癌的特异性为96.3%,敏感性为85.7%。与超声评估系统比较,细针穿刺细胞学检查结果诊断符合率为80.4%,诊断甲状腺癌的特异性为90.4%,敏感性为43.4%。结论甲状腺结节细针穿刺细胞学检查及超声评估系统对术前良恶性甲状腺结节的鉴别诊断价值较高,临床上值得应用和推广。  相似文献   

9.
目的:探讨超声造影对鉴别甲状腺结节良恶性诊断的特异性和敏感性,为甲状腺结节的诊断提供依据。方法:收集85例(123个结节)常规超声检测出且定性困难的甲状腺结节患者,均行甲状腺超声造影检查后行手术切除并进行组织病理学检查,比较超声造影检查的敏感性和特异性;不同造影模式、单发或多发结节对恶性结节诊断的价值;以及超声造影对不同大小结节的诊断价值。结果:与组织病理学比较超声造影诊断的特异性为91.8%,敏感性为86.0%,准确性为90.2%,阳性预测值为86.0%,阴性预测值91.8%。低增强和单发结节对甲状腺癌的诊断有帮助,环状增强对良性病变诊断有帮助;造影呈低增强且小于1cm的结节恶性可能性较大。结论:超声造影对结节良、恶性诊断的敏感性及特异性较好,对甲状腺结节的诊断和鉴别诊断有价值。  相似文献   

10.
目的:总结分析桥本氏甲状腺炎声像图特征,并探讨超声对桥本背景下甲状腺结节良恶性鉴别诊断价值。方法:选取超声科行超声检查并经手术病理证实的80例桥本氏甲状腺炎合并甲状腺结节患者(良性40例,恶性40例)声像图资料,运用统计学方法,归纳并总结。结果:桥本氏甲状腺炎声像图多表现为:甲状腺两侧叶弥漫性肿大,一般为对称性,也可一侧肿大为主,峡部增厚明显;表面凹凸不平,形成结节状表面,形态僵硬,边缘变钝,探头压触有硬物感;腺体内为不均匀低回声,可见疑结节样回声,但边界不清,不能在多切面上重复,有时仅表现为局部回声减低,有的可见细线样强回声形成不规则的网络样改变;内部可有小的囊性变;彩色多普勒显示甲状腺内血流较丰富,有时几乎呈"火海征",甲状腺上动脉流速偏高、内径增粗,但动脉流速和阻力指数明显低于甲亢。在桥本背景下,对桥本背景下甲状腺结节进行分析,运用Logistic回归统计学方法,诊断甲状腺结节良恶性各项超声指标权重排序如下(自大至小):形态、纵横比(A/T)、回声水平、彩色多普勒血流信号(CDFI)、边界、声晕、钙化模式。其中"形态不规则"诊断甲状腺恶性结节敏感性、特异性、准确性、阳性预测值、阴性预测值分别为95.0%、55.0%、75.0%、67.8%、91.6%;"A/T≥1"诊断甲状腺恶性结节敏感性、特异性、准确性、阳性预测值、阴性预测值分别为45.0%、87.5%、66.3%、78.3%、61.4%;"回声水平"诊断甲状腺恶性结节敏感性、特异性、准确性、阳性预测值、阴性预测值分别为92.5%、57.5%、75.0%、68.5%、88.4%;"血流丰富"诊断甲状腺恶性结节敏感性、特异性、准确性、阳性预测值、阴性预测值分别为65.0%、75.0%、70.0%、72.2%、68.1%;"边界不清"诊断甲状腺恶性结节敏感性、特异性、准确性、阳性预测值、阴性预测值分别为92.5%、57.5%、75.0%、68.5%、88.5%;"不规则晕环"诊断甲状腺恶性结节敏感性、特异性、准确性、阳性预测值、阴性预测值分别为95.0%、37.5%、66.2%、60.3%、88.2%;"微钙化"诊断甲状腺恶性结节敏感性、特异性、准确性、阳性预测值、阴性预测值分别为87.5%、70.0%、78.7%、74.5%、84.8%。结论:超声对桥本氏甲状腺炎有较好的诊断价值,同时,对桥本背景下结节的良恶性鉴别诊断,超声有较高的诊断价值。  相似文献   

11.
Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P < 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (>0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P <0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P < 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.  相似文献   

12.
Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.  相似文献   

13.
Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P< 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P< 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.  相似文献   

14.
目的:评价使用安心颗粒对急诊经皮冠状动脉介入术(PPCI)术后生活质量的影响.方法:将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组(术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次)和对照组(仅接受基础药物治疗).所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表(MIDAS)、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果:入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异(P>0.05);出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低(P<0.05);组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低(P<0.05).两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血(P>0.05).两组发生轻度血小板减少症的患者数比较无差异(P>0.05).结论:PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.  相似文献   

15.
Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P<0.01);the MAP decreased(P<0.01)and the HR increased drastically(P<0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.  相似文献   

16.
Objective:To investigate the gene expression of osteoprotegerin(OPG) and osteoclast differentiation factor(ODF) in the bone tissue of patients with hip fracture due to osteoporosis. Methods:OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers(over 50 years old) with hip fracture(Observer Group) and 30 cases of hip facture sufferers with no osteoporosis(Control group) were analyzed with the Semi-Quantitative RT-PCR method. Results:The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion:Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.  相似文献   

17.
Objective:To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas(SPTP). Methods:Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin(HE) staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results:Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin(9/9 cases), AAT(9/9 cases), NSE(9/9 cases), ACT(7/9 cases), CK20(2/9 cases), CgA(1/9 cases), S-100(3/gcases), PR(4/gcases), Syn(3/9 cases) and CD56(5/9cases), negative in CEA and ER. Conclusion:SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.  相似文献   

18.
Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.  相似文献   

19.
Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.  相似文献   

20.
Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.  相似文献   

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