超声弹性成像参数联合血清MMP-9、HMGB-1、TG诊断甲状腺癌临床价值及与淋巴结转移的关系

目的分析超声弹性成像参数联合血清基质金属蛋白酶-9(MMP-9)、高迁移率族蛋白B1(HMGB-1)、甲状腺球蛋白(TG)在甲状腺癌临床诊断中的价值及与淋巴结转移的关系。方法选取2017年1月-2019年1月皖北煤电集团总医院超声科诊断甲状腺癌患者126例作为甲状腺癌组(腺癌组),甲状腺良性结节患者126例作为甲状腺良性结节组(结节组)。2组均进行超声弹性成像检查及血清MMP-9、HMGB-1、TG水平检测,比较2组患者超声弹性成像参数(蓝色面积比值、弹性比值)及血清各指标水平,应用Logistic回归分析甲状腺癌发生的危险因素,并分析血清各指标及超声弹性成像参数与甲状腺癌患者淋巴结转移的相关性,采用ROC曲线分析超声弹性成像参数、血清各指标对甲状腺癌的诊断价值。结果腺癌组血清MMP-9、HMGB-1、TG水平高于结节组(t=13.022、10.571、12.015,P均<0.001),蓝色面积比值、弹性比值均高于结节组(t=6.537、8.765,P均<0.001);腺癌组有淋巴结转移患者血清MMP-9、HMGB-1、TG水平及蓝色面积比值、弹性比值高于无淋巴结转移患者(t=4.097、3.091、2.528、5.667、6.679,P均<0.05)。Spearman相关性分析,血清MMP-9、HMGB-1、TG水平及蓝色面积比值、弹性比值与甲状腺癌患者淋巴结转移呈显著正相关(r=0.624、0.728、0.709、0.661、0.687,P均<0.001)。超声弹性成像参数及血清指标联合诊断甲状腺癌的AUC为0.919,敏感度为90.48%,特异度为86.51%。Logistic回归分析,血清MMP-9、HMGB-1、TG、蓝色面积比值、弹性比值均为甲状腺癌发生的重要危险因素(P均<0.05)。结论超声弹性成像参数及血清MMP-9、HMGB-1、TG与甲状腺癌患者淋巴结转移密切相关,联合检测可为甲状腺癌临床诊断提供一定依据。

Clinical value of ultrasound elastography parameters combined with serum MMP-9,HMGB-1,thyroglobulin in the diagnosis of thyroid cancer and its relationship with lymph node metastasis

Objective To analyze the value of ultrasonic elastic imaging parameters combined with serum matrix metalloproteinase-9(MMP-9),high mobility protein B1(HMGB-1),thyroglobulin(TG)in the clinical diagnosis of thyroid cancer and the transfer relationship between them and lymph node metastasis.Methods From January 2017 to January 2019,126 patients with thyroid cancer diagnosed by the Ultrasound Department of Wanbei Coal and Electricity Group General Hospital were selected as thyroid cancer group(adenocarcinoma group),and 126 patients with thyroid benign nodule were selected as thyroid benign nodule group(nodule group).Ultrasound elastography and serum MMP-9,HMGB-1,and TG levels were measured in both groups.Ultrasound elastography parameters(blue area ratio,elastic ratio),and serum levels of patients with lymph node metastasis were compared between the two groups.The logistic regression was used to analyze the causes of thyroid cancer,and the correlation between ultrasound elastography parameters and serum parameters and lymph node metastasis in patients with thyroid cancer was analyzed.The diagnostic value of ultrasound elastography parameters and serum indicators for thyroid cancer was observed.Results The levels of MMP-9,HMGB-1 and TG in adenocarcinoma group were higher than those in nodule group(t=13.022,t=10.571,t=12.015,P<0.001),the blue area ratio and elastic ratio were higher than those in nodule group(t=6.537,t=8.765,P<0.001);The serum MMP-9,HMGB-1,TG levels and blue area ratio,elastic ratio in patients with lymph node metastasis were higher than those in patients without lymph node metastasis(t=4.097,t=3.091,t=2.528,t=5.667,t=6.679,P<0.05);Spearman correlation analysis showed that serum MMP-9,HMGB-1 and TG levels blue area ratio,elastic ratio,were positively correlated with lymph node metastasis(r=0.624,r=0.728,r=0.709,r=0.661,r=0.687,P<0.001);The combination of ultrasound elastography parameters and serum parameters for the diagnosis of thyroid cancer has the largest AUC of 0.919,which is higher than the single index diagnosis.The sensitivity for the diagnosis of thyroid cancer is 90.48%and the specificity is 86.51%;Logistic regression analysis,blue area ratio,elastic ratio,serum MMP-9,HMGB-1,and TG are all important risk factors for thyroid cancer(OR=2.607,OR=2.801,OR=2.451,OR=2.172,OR=2.772,P<0.05).Conclusion Ultrasound elastography parameters and serum MMP-9,HMGB-1,TG are closely related to lymph node metastasis in patients with thyroid cancer,and its detection can provide a basis for clinical diagnosis of thyroid cancer.