甲状腺球蛋白预测甲状腺乳头状癌颈部淋巴结转移的增益价值

目的:探讨甲状腺球蛋白(thyroglobulin，Tg)在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部淋巴结转移预测中的临床价值。方法:回顾性分析甲状腺乳头状癌清甲结束后患者 218例，根据全身131I扫描结果分为无淋巴结转移组、一枚淋巴结转移组、两枚淋巴结转移组及多枚淋巴结转移组。分析各组患者组间Tg值的差异与相关性，采用ROC曲线计算达到最佳诊断效能时的Tg值。结果:无淋巴结转移组与淋巴结转移组之间Tg值有统计学差异(P＜0.05)，不同数目淋巴结转移组之间Tg值无统计学差异(P＞0.05)，且Tg值与淋巴结转移灶数目无相关性(P＞0.05)。当Tg值为1.5 ng/mL时诊断淋巴结转移的灵敏度68%，特异度80%，准确性72%，ROC曲线下面积达到最大值0.77。结论:尚不能依据Tg值判断甲状腺乳头状癌术后淋巴结转移数目及范围，但可以评估清甲治疗后淋巴结转移可能性，本研究建议的Tg截断值为1.5 ng/mL。

The gain value of thyroglobulin in predicting cervical lymph node metastasis in papillary thyroid carcinoma

Objective:Rearching the clinical effectiveness of thyroglobulin (Tg) prediction of cervical lymph node metastasis of papillary thyroid carcinoma(PTC).Methods:218 PTC patients who underwent removing residual thyroid tissue were included in the study.Patients were divided into no lymph node metastasis group,a lymph node metastasis group,two pieces of lymph node metastasis group and more than two lymph node metastasis group,according to the whole body 131I scanning.We compared the differences between each group,and analyzed the differences and correlations of serum Tg value in each group.The maximum diagnostic efficiency of serum Tg was detected by ROC curve.Results:There was difference in serum Tg value between the group without lymph node metastasis and the group with lymph node metastasis (P＜0.05).There was no statistical difference in Tg between groups with different number of lymph node metastasis (P＞0.05) and serum Tg value had no correlation with the number of lymph node metastasis (P＞0.05).Further,the sensitivity,specificity,accuracy of the diagnosis of lymph node metastasis were 68%,80%,72% when Tg was 1.5 ng/mL,meanwhile the area under ROC curve reached the maximum 0.77.Conclusion:Serum Tg value has certain clinical value in determining the possibility of lymph node metastasis postoperative TPC,but the number and degree of metastasis cannot be determined according to its level.The recommended cutoff for predicting the diagnostic efficacy of lymph node metastasis after removing residual thyroid tissue is 1.5 ng/mL.