甲状腺球蛋白及抗甲状腺球蛋白抗体联合颈部超声在分化型甲状腺癌复发或转移灶诊断中的价值

目的 探讨甲状腺球蛋白(TG)、抗甲状腺球蛋白抗体(TGAb)联合颈部超声在诊断分化型甲状腺癌(DTC)治疗后复发或转移灶中的临床价值.方法 64例患者均为DTC术后131I清除残余甲状腺治疗后,行再次131I治疗前检测血清TGAb、TG水平,并行颈部超声检查,在131I治疗后1周行131I全身SPECT扫描(WBS).结果 对DTC复发或转移灶诊断的灵敏度、特异性和准确性:TG分别为76.9%、66.7%和75%;超声为79%、58%和75%;TG联合超声为96.8%、71.4%和92.1%.12例TG假阴性患者中,有10例患者TGAb≥,100 IU/ml,其TG诊断的灵敏度、特异性和准确性均明显降低.Logistic回归分析结果显示:TG阳性组患者WBS阳性风险是阴性组患者的8.591倍.超声阳性患者WBS阳性风险是阴性患者的6.953倍.结论 TG联合超声能显著提高对DTC治疗后复发或转移灶诊断的灵敏度、特异性和准确性;运用TG监测DTC治疗后复发或转移灶,应同时检测TGAb.

Diagnostic value of combing TG,TGAb and cervical ultrasonic examination in the recurrence or metastasis lesion of differentiated thyroid carcinoma after treatment

Objective To study the clinical value of thyroglobulin（TG）,antithyroglobulin antibody（TGAb）combined ultrasonic examination（US）in the diagnosis of recurrence or metastatic lesion of differentiated thyroid carcinoma（DTC）.Methods 64 patients with DTC after surgical treatment and 131I radiotherapy were applied with 131I again,serum TG and TGAb levels and cervical ultrasonic examination were performed before 131I radiotherapy,and 131I whole body SPECT scan（WBS）were performed a week later followed 131I radiotherapy.Rusults In 64 patients,the sensitivity of TG and US in diagnosis of DTC recurrence or metastatic lesion were 76.9% and 79%,the specificity were 66.7% and 58%;and the accuracy were 75% and 75%,respectively.The total sensitivity,total specificity and total accuracy of combination TG with US were 96.8%,71.4% and 92.1%,respectively.Among 12 cases of patients with false negative for TG,there were 10 patients with TGAb≥100 IU/ml.For the patients with TGAb≥100 IU/ml,the diagnostic sensitivity,specificity and accuracy of TG were significantly diminished,contrasted to patients with TGAb100 IU/ml.The results of Logistic regression analysis showed：the WBS positive risk of the patients in the TG positive group was 8.591 times higher than the negative group,and the US positive risk was 6.953 times.Conclusions The combination TG with US could improve the sensitivity,specificity,and accuracy of diagnosis in DTC recurrence or metastatic lesion.The level of TGAb should be detected in the process of using TG as the monitor index of DTC recurrence or metastatic lesion after treatment.