新疆医科大学学报

目的探讨术前血清促甲状腺激素(TSH)水平联合多普勒超声诊断分化型甲状腺癌(DTC)的相关性及临床诊断意义。方法回顾性分析新疆医科大学第一附属医院血管甲状腺外科行甲状腺切除术并经病理检查确诊的200例分化型甲状腺癌(DTC)患者(DTC组)和200例甲状腺良性结节患者(对照组)的术前血清TSH及多普勒超声结果,比较两组患者的一般资料、血清TSH水平与超声指标的异同,并分析术前血清TSH与多普勒超声指标联合检测诊断DTC的ROC曲线下面积、最佳临界值、敏感性及特异性。结果 DTC组与对照组在年龄、性别、民族方面差异无统计学意义。DTC组术前血清TSH水平高于对照组(P<0.05),两组患者的超声指标中边界、形态比较差异无统计学意义(P>0.05);而数目、大小、有无沙粒样钙化灶比较差异有统计学意义(P<0.05)。术前血清TSH诊断DTC的ROC曲线下面积为0.688(P<0.05),且其最佳临界值为2.515 mIU/L,敏感度为57.5%,特异度为75.5%;而术前血清TSH联合超声指标诊断DTC的ROC曲线下面积为0.751(P<0.05)且TSH的最佳临界值为3.153mIU/L,敏感度为70.1%,特异度为80.2%。结论确诊为甲状腺结节患者完善术前血清TSH与多普勒超声诊断DTC的准确性较单独检测高,对进一步制定治疗方案有一定的指导意义。

Objective To disscuss the correlation between preoperative serum thyroid stimulating hormone(TSH)level and Doppler ultrasonography in benign and malignant thyroid nodules and its clinical significance.Methods By a retrospective analysis,the intervention group 200 patients with differentiated thyroid carcinoma(DTC)and the contrast group 200 patients with benign thyroid nodules operated thyroidectomy and pathologic examination in Department of Vascular and Thyrorid of the First Affiliated Hospital of Xinjiang Medical University are used to compare the clinical data:the differences between serum TSH levels and ultrasonic indicators,and analyzing the curve of ROC and the optimal critical value,sensitivity and specificity by a combining examination by the preoperative TSH and Doppler ultrasound in diagnosis of DTC.Results There are not statistically significant in age,gender,and ethnicity in the DTC group and the control group.The level of serum TSH in DTC group was higher than that in control group(P <0.05).There was no statistically significant difference in the boundary,form of the ultrasonic indexes of two groups(P >0.05),while there were statistically significant differences(P <0.05)in the number,size,with or without Sand like calcification foci.The accuracy of preoperative TSH combined with ultrasound in the diagnosis of DTC was higher than that of TSH alone.Conclusion The accuracy of preoperative serum TSH and Doppler ultrasound in the diagnosis of thyroid nodules in patients with DTC was higher than that of the single detection,which had a certain guiding significance for further treatment.