论文部分内容阅读
[目的]探讨动态监测131I治疗前刺激性甲状腺球蛋白(s Tg)在伴有远处转移的分化型甲状腺癌(DTC)诊治中的意义。[方法]221例甲状腺全切或次全切术后拟行131I治疗的DTC患者,根据是否存在远处转移分为M1组(50例)和M0组(171例)。动态监测131I治疗前s Tg及相应促甲状腺激素(TSH)水平(首次测量值记为Tg1、TSH1,末次记为Tg2、TSH2)。分别计算s Tg变化值(△Tg)及其变化速度(v Tg)、Tg/TSH变化值(△Tg’)及其变化速度(v Tg’),以及s Tg随TSH变化比值(△Tg/△TSH)。将以上各s Tg变化指标分别与Tg1、Tg2结合,建立Logistic回归方程,并用ROC曲线及最佳诊断界值点(DCP)评估各指标单独及联合应用在判断远处转移性DTC的价值。[结果]s Tg变化指标中,△Tg/△TSH对远处转移性DTC的诊断更有价值,界值范围为-0.40~0.44ng/μIU,对应灵敏度、特异性、准确率分别为90.00%、88.89%和89.14%。△Tg/△TSH结合s Tg水平(Tg1或Tg2)联合判断DTC远处转移的ROC曲线下面积(AUC)可达0.971,特异性93.57%,准确率92.31%,较两者单独应用时均有提高。[结论 ]131I治疗前动态监测s Tg对伴有远处转移DTC的诊疗具有增益效应,s Tg随TSH变化比值(△Tg/△TSH)与s Tg水平结合有助于提高DTC远处转移诊断的准确率和特异性,为DTC 131I治疗前评估及治疗策略的制定提供依据。
[Objective] To investigate the significance of dynamic monitoring of s Tg in patients with differentiated thyroid carcinoma (DTC) with distant metastasis before dynamic 131I treatment. [Method] 221 cases of 131I-treated DTC patients undergoing total thyroidectomy or subtotal thyroidectomy were divided into M1 group (50 cases) and M0 group (171 cases) according to the presence or absence of distant metastasis. Dynamic monitoring of sI before 131I treatment and corresponding thyroid stimulating hormone (TSH) levels (the first measurement was recorded as Tg1, TSH1, the last recorded as Tg2, TSH2). The changes of s Tg and v Tg, the changes of Tg / TSH and the changes of v Tg ’and the ratios of s Tg to TSH (△ Tg / △ TSH). The above indexes of s Tg were respectively combined with Tg1 and Tg2 to establish Logistic regression equation. The ROC curve and the best diagnostic value (DCP) were used to evaluate the value of each index alone and in combination to determine the value of distant metastatic DTC. [Results] △ Tg / △ TSH was more valuable for the diagnosis of distant metastatic DTC in s Tg, the range of cutoff was -0.40 ~ 0.44ng / μIU, the corresponding sensitivity, specificity and accuracy were 90.00% , 88.89% and 89.14% respectively. The area under the curve of AUC of △ Tg / △ TSH combined with s Tg (Tg1 or Tg2) in predicting the distant metastasis of DTC was 0.971, the specificity was 93.57% and the accuracy was 92.31% improve. [Conclusion] The dynamic monitoring of s Tg before 131I has a gain effect on the diagnosis and treatment of DTC with distant metastasis, and the combination of △ Tg / △ TSH and s Tg in s Tg can help to improve the diagnosis of distant metastasis of DTC The accuracy and specificity of DTC 131I for the treatment of pre-treatment evaluation and treatment to provide the basis for the formulation.