动态危险度评估在中高危无远处转移性分化型甲状腺癌患者随访中的意义

目的动态评估中高危无远处转移性分化型甲状腺癌(DTC)患者复发风险的变化,为后续治疗及随访策略提供参考。方法纳入184例中高危无远处转移患者(中危111例、高危73例),根据动态危险度评估体系评估初始治疗后早期(6～12个月)的治疗疗效反应,将患者分为2组:早期疗效良好(ER)组(n=113)和早期疗效欠佳组(n=71),比较两组的一般临床病理特征;观察所有患者以及亚组分析中危和高危患者在初始治疗后早期和随访期末的动态危险度变化。结果与早期ER组患者相比,早期疗效欠佳组肿瘤直径较大(U=2771.500,P=0.000)、易于腺外侵犯(χ²=4.070,P=0.044)以及¹³¹I治疗前刺激性甲状腺球蛋白水平更高(U=1367.500,P=0.000);早期疗效欠佳组患者中31%仅经过促甲状腺激素(TSH)抑制治疗,在随访期末转变为疗效良好[其中63.6%为中危患者尤以疗效不确切(IDR)患者居多,高危患者占36.4%];有6例(5.2%)早期ER患者在随访期末转变为IDR、血清学疗效欠佳甚至结构学疗效欠佳(1例中危患者经病理学证实颈部淋巴结...     

分化型甲状腺癌患者血清Tg和TgAb检测与结果分析应注意的问题

Tg(甲状腺球蛋白)是非常重要的随访分化型甲状腺癌的血清肿瘤标志物。但是,保证血清Tg检测的精密度和可靠性仍是目前体外检验最为困难的问题之一,不论采用哪种检测方法,TgAb(甲状腺球蛋白抗体)的干扰都是影响血清Tg检测结果最为重要的因素。本文对分化型甲状腺癌患者血清Tg及TgAb检测与临床结果分析时应注意的若干问题进行了简要综述。     

Ablation of Cervical Lymph Nodes in Patients with Thyroid Cancer: A Comparison between Cryoablation and Percutaneous Ethanol Injection

The purpose of this study was to retrospectively evaluate the safety and efficacy of cryoablation and compare the outcomes with those of percutaneous ethanol injection (PEI) for the treatment of metastatic cervical lymph nodes (CLNs) in patients with thyroid cancer. The study included 24 patients with 47 CLNs treated with PEI and 7 patients with 11 CLNs treated with cryoablation. Three of 7 (42.9%) patients did not respond to PEI and progressed to cryoablation. There were more local recurrences in CLNs treated with PEI (7/47, 14.9%) compared with cryoablation (0/11, 0%), but this did not reach significance (P = .33). There was no difference in mild/moderate (3/24, 12.5% vs 2/7, 28.6%; P = .31) or severe (1/24, 4.2% vs 0/7, 0%; P = 1) adverse events in the PEI and cryoablation cohorts. The number of treatments required for CLNs treated with PEI (2 ± 1.1) was significantly greater than those for CLNs treated with cryoablation (1 ± 0) (P = .002). These limited data suggest that the treatment of metastatic CLNs with cryoablation or PEI may both be safe and effective; however, further data are needed to confirm superiority of cryoablation.     

Prognostic value of postoperative stimulated thyroglobulin in differentiated thyroid cancer

BackgroundThyroglobulin (Tg) level is used for long-term follow-up of differentiated thyroid cancer (DTC). However, the prognostic value of the postoperative level and the level which can be considered risky are not clear in literature.PurposeTo evaluate the prognostic value of postoperative Tg in DTC for subsequent disease-free status. Also, to determine the cutoff with the highest sensitivity and specificity.MethodsA retrospective analysis was performed of 62 patients with non-metastatic DTC presenting to our department from January 2018 to December 2019. Three groups were formed according to postoperative stimulated thyroglobulin (sTg) level: <1 ng/ml, 1-5 ng/ml, and >5 ng/ml. Outcomes were compared at 12 months. ROC curve analysis determined the cutoff with the highest sensitivity and specificity.ResultsSeven the 62 patients showed persistent or recurrent disease at 12 months after diagnosis. Comparing outcomes in the 3 sTg groups showed thyroglobulin to be a significant prognostic variable. A cut-off of 3.15 ng/ml had the highest sensitivity and specificity on ROC curve analysis.ConclusionPostoperative stimulated thyroglobulin is a useful prognostic tool in the postoperative categorization of patients and can subsequently be tested for its value to guide radioactive iodine therapy.     

正常人甲状腺单层细胞培养甲状腺球蛋白分泌的研究

用手术切除的甲状腺腺瘤旁相对正常的甲状腺组织10例,经组织制备与甲状腺单层细胞培养。用bTSH10、10~2和10~3μu/ml的三个浓度及先后分0天、3天和6天三个时间,观察不同浓度bTSH与不同培养天数对甲状腺单层细胞产生Tg值的变化,未用bTSH的基础培养下0天的Tg基础对照值为每孔4.90±0.07ng/ml,3天、6天升高不显著。各浓度bTSH刺激甲状腺细胞后第3天6天与0天,以及6天与3天相比均有显著升高。各浓度bTSH刺激后Tg的分泌值与相应日对照值均有显著升高,而各浓度间两两比较,仅第6天在bTSH三个浓度刺激下其释放Tg值有量效关系,而第3天则无统计学差别。实验结果证明正常人甲状腺单层细胞培养中bTSH具有促进分泌的能力。     

GWAS of Chronic Spontaneous Urticaria Reveals Genetic Overlap with Autoimmune Diseases,Not Atopic Diseases

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