摘要 目的探讨超声特征、弹性成像及血清促甲状腺激素(TSH)水平在分化型甲状腺癌(DTC)术前诊断中的参考价值。方法采用回顾性分析方法,收集2018年9月至2020年1月在哈尔滨医科大学附属第四医院进行甲状腺手术治疗患者的临床资料。患者术前均进行常规超声、弹性成像检查和血清TSH水平测定。根据患者手术病理检查结果将患者分为良性组和DTC组,采用χ2检验和多因素logistic回归方法分析超声特征及弹性评分,评价DTC发生的原因;建立多因素logistic回归模型,利用回归模型绘制受试者工作特征曲线(ROC曲线),通过分析ROC曲线下面积(AUC)、敏感度、特异度及准确度,判断超声特征、弹性成像及血清TSH水平在DTC术前诊断中的参考价值。结果共收集81个患者的临床资料,其中男性17例、女性64例,年龄为(48.72±10.58)岁;良性组37例,男性10例、女性27例,年龄为(53.24±9.59)岁;DTC组44例,男性7例、女性37例,年龄为(44.91±9.95)岁;两组年龄比较差异有统计学意义(t=3.822,P<0.05),性别比例比较差异无统计学意义(χ2=1.498,P>0.05)。DTC组结节数量、大小、回声水平、微钙化、纵横比及弹性评分与良性组比较差异均有统计学意义(χ2=49.000、4.457、32.111、5.444、4.457、49.926,P均<0.05),多因素logistic分析显示,低回声、有微钙化、纵横比>1及高弹性评分是DTC发生的危险因素(OR=8.042、4.787、4.160、2.380,P均<0.05),多因素logistic回归模型预测DTC的ROC曲线分析显示,AUC为0.841(95%CI=0.743~0.939),敏感度为90.91%,特异度为72.97%,准确度为82.72%;血清TSH水平预测DTC的ROC曲线分析显示,AUC为0.721(P<0.05),敏感度为72.70%,特异度为64.90%,准确度为54.30%,TSH最佳截断值为2.215μU/ml。结论在DTC的术前诊断中,超声特征、弹性成像及血清TSH水平对DTC诊断均有重要的临床参考价值,多因素logistic回归模型的建立有利于提高临床医生对DTC发生的预测� Objective To investigate the reference value of ultrasonography(US)image features,elastography and serum thyroid stimulating hormone(TSH)levels in preoperative diagnosis of differentiated thyroid carcinoma(DTC).Methods Retrospective analysis was conducted to collect clinical data of patients undergoing thyroid surgery in the Fourth Affiliated Hospital of Harbin Medical University from September 2018 to January 2020.All patients underwent conventional ultrasound,elastography examination and serum TSH level measurement before surgery;patients were divided into benign group and DTC group according to the results of pathological results of the operation,and the US image features and elasticity score were analyzed by chi-square test and multivariate logistic regression to evaluate the causes of DTC;a multivariate logistic regression model was established and the receiver operating characteristic curve(ROC)was drawn with the regression model,by analyzing the area under the ROC curve(AUC),sensitivity,specificity and accuracy,the reference value of US image features,elastography and serum TSH levels in the preoperative diagnosis of DTC were judged.Results Clinical data of 81 patients were collected,including 17 men and 64 women,aged(48.72±10.58)years.In benign group,there were 37 cases,including 10 men and 27 women,with age of(53.24±9.59)years;there were 44 patients in DTC group,including 7 men and 37 women,with age of(44.91±9.95)years old,the age difference between benign group and DTC group was significant(t=3.822,P<0.05),while the gender difference was not statistically significant(χ2=1.498,P>0.05).There were significant differences in the number,size,echo level,microcalcification,aspect ratio and elasticity score between benign group and DTC group(χ2=49.000,4.457,32.111,5.444,4.457,49.926,P<0.05);multivariate logistic analysis showed that hypoecho,microcalcification,aspect ratio>1 and elasticity score were risk factors for DTC(OR=8.042,4.787,4.160,2.380,P<0.05),the ROC curve of the multivariate logistic re
机构地区 哈尔滨医科大学附属第四医院超声科
出处 《中华地方病学杂志》 CAS 北大核心 2021年第5期394-398,共5页 Chinese Journal of Endemiology
基金 黑龙江省自然科学基金重点项目(ZD2017016)。
关键词 超声检查 弹性成像 促甲状腺激素 分化型甲状腺癌 Ultrasonography Elastography Thyroid stimulating hormone Differentiated thyroid carcinoma
分类号 R73 [医药卫生—肿瘤]
