血清TSH,TPOAb和TGAb水平在良恶性甲状腺结节中的鉴别诊断价值

目的 研究促甲状腺激素(thyroid stimulating horomone,TSH)和甲状腺自身抗体(TPOAb,TGAb)在良恶性甲状腺结节中的鉴别诊断价值。方法 采用回顾性调查研究方法,收集中国人民解放军联勤保障部队第九○一医院2013年3月～2018年9月期间因甲状腺结节行手术治疗且经病理证实的500例临床资料,其中分化型甲状腺癌(differentiated thyroid carcinoma,DTC)152例,甲状腺腺瘤(thyroid adenoma,TA)232例,结节性甲状腺肿(nodular goiter,NG)116例,并对检测结果进行统计分析。结果 DTC组的TSH,TPOAb和TGAb水平显著高于TA组和NG组,经单因素方差分析,差异有统计学意义(F=4.120,4.636,6.638; P=0.016,0.01,0.001)。TSH在DTC组与良性甲状腺疾病的阳性率无差别,TPOAb在DTC组的阳性率为30.2%,而在TA组和NG组的阳性率分别为12.5%和13.7%,差异有统计学意义(χ2=21.43,P<0.01)。DTC组的TGAb阳性率为26.9%,而TA和NG组的阳性率分别为15.5%和12.0%,差异有统计学意义(χ2=11.91,P=0.002)。转移性DTC和未转移性DTC组的TSH,TPOAb和TGAb,经t检验统计分析,差异无统计学意义(t=1.976,1.974,1.973; P=0.572,0.574,0.577)。TPOAb和TGAb在鉴别DTC和TA的曲线下面积分别是0.612和0.610。TPOAb和TGAb在鉴别DTC和NG的曲线下面积分别是0.577和0.620。TGAb在最佳临界点诊断DTC的敏感度为73.7%,特异度为52.6%。结论 TSH浓度和甲状腺自身抗体水平升高与DTC的发病有一定的相关关系,TGAb在甲状腺癌和甲状腺良性结节的鉴别诊断中具有一定价值。

Diagnostic Value of Thyroid Autoantibodies and TSHin Thyroid Nodules

Objective To investigate the diagnostic value of thyroid stimulating hormone(TSH)and thyroid autoantibodies(TPOAb,TGAb)in benign and malignantthyroid nodules.Methods A retrospective investigation method was used to collect the pathological and clinical data of 500 cases of thyroid nodules treated with surgery and pathological confirmation from March 2013to September 2018,including 152 cases of papillary thyroid carcinoma,232 casesof thyroid adenomas,and 116 cases of nodular goiter.Results The levels of TSH,TPOAb and TGAb in the thyroid cancer group were significantly higher than those of the thyroid adenomas group and the nodular goiter group(F=4.120,4.636 and 6.638; P=0.016,0.01,0.001).The positiverate of TSH in thyroid cancer and benign thyroid disease groups was not significantly different,but the positive rate of TPOAb and TGAb was significantly higher than that of two other groups.The positive rate of TPOAb in thyroid papillary carcinoma was 30.2%,and the positive rates of thyroid adenomas group and thethyroid nodular goiter group were 12.5% and 13.7%(χ2=21.43,P<0.01)respectively.The positive rate of TGAb in papillary thyroid carcinoma was 26.9%,while the positive rate in thyroid adenomas and nodular goiter was 15.5%and 12.0%(χ2=11.91,P=0.002)respectively.TSH,TPOAb and TGAb of metastatic DTC and non-DTC groups were statistically analyzed by t test,the difference was not statistically significant(t=1.976,1.974 and 1.973,P=0.572,0.546 and 0.577).The ROC curve analysis showed that the areas under the curve of the papillary carcinoma and thyroid adenomas were 0.612 and 0.610,respectively.To diagnose papillary carcinoma and nodular goiter,the areasunder the curve of TPOAb and TGAb were 0.577 and 0.620,respectively.The sensitivity of TGAb to diagnose thyroid cancer at the optimal critical point was 73.7%,and the specificity was 52.6%.Conclusion The increase of TSH concentration and thyroid autoantibodies had a little correlation with the incidence of papillary thyroid cancer.TGAb has preliminary diagnostic value for thyroid cancer.