2019 年第 7 期 第 14 卷

血清促甲状腺激素和甲状腺过氧化物酶抗体及甲状腺球蛋白抗体在良恶性甲状腺结节鉴别诊断中的临床意义

Clinical significances of serum thyroid stimulating hormone, thyroid peroxidase antibody and thyroglobulin antibody in differential diagnosis of benign and malignant thyroid nodules

作者：张瀚月段文冰张璐璐许瑞刘义刚王燕红唐闻刘芸

英文作者：

单位：250021济南，山东大学附属省立医院临床医学检验部

英文单位：

关键词：甲状腺结节；甲状腺癌；促甲状腺激素；甲状腺球蛋白抗体；甲状腺过氧化物酶抗体

英文关键词：

• 摘要：

• 【摘要】目的    分析良恶性甲状腺结节患者血清中促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPO-Ab）和甲状腺球蛋白抗体（Tg-Ab）水平，探讨血清TSH、TPO-Ab、Tg-Ab水平在良恶性甲状腺结节诊断中的意义。方法    选取2017年1月1日至2018年6月30日因甲状腺结节就诊于山东大学附属省立医院乳腺甲状腺外科患者381例，按术后病理诊断结果分为良性甲状腺结节组（BTN 组，250例）、单纯甲状腺癌组（TC组，77例）、甲状腺癌伴结节性甲状腺肿组（TC+NG组，54例）。另选取同期查体健康人员200名为正常对照组（N组）。比较4组术前血清TSH、TPO-Ab、Tg-Ab水平和TSH、TPO-Ab、Tg-Ab阳性率，分析甲状腺癌患者血清TSH、TPO-Ab、Tg-Ab水平与肿瘤临床病理特征的相关性，探讨甲状腺癌的危险因素。结果    TC组和TC+NG组TSH、TPO-Ab、Tg-Ab水平均明显高于N组和BTN组［2.37（1.66,3.30）、2.26（1.55,3.28）mIU/L比1.96（1.41,2.55）、1.86（1.28,2.49）mIU/L；28.00（14.28,37.95）、23.89（10.16,28.53）kIU/L比13.60（8.20,22.00）、16.49（12.92,28.00）kIU/L；19.25（15.00,148.79）、19.16（10.00,186.50）kIU/L比13.32（9.00,36.28）、14.24（12.74,40.17）kIU/L］，BTN组TPO-Ab水平明显高于N 组（均P＜0.01）。TC组和TC+NG组TSH、Tg-Ab、TPO-Ab阳性率均明显高于N组和BTN组（均P＜0.01）；TC组TPO-Ab阳性率明显高于TC+NG组（P＜0.05）。甲状腺癌患者血清TSH水平与性别、病灶直径、淋巴结转移、肿瘤分期明显相关（均P＜0.05），TPO-Ab、Tg-Ab水平与临床病理特征均无相关性（均P＞0.05）。多因素Logistic回归分析显示，TSH增高及Tg-Ab增高是甲状腺癌的独立危险因素（比值比=2.043、1.080，95%置信区间：1.480～2.830、1.029～1.103，均P＜0.001）。结论    血清TSH、TPO-Ab、Tg-Ab水平与甲状腺癌的发生与发展密切相关，在甲状腺良性结节和甲状腺癌的鉴别诊断中有重要的临床价值。

• 【Abstract】Objective    To explore the clinical significances of serum thyroid stimulating hormone（TSH）, thyroid peroxidase antibody（TPO-Ab） and thyroglobulin antibody（Tg-Ab） in differential diagnosis of benign and malignant thyroid nodules. Methods    A total of 381 patients with thyroid nodules undergoing surgical resection in Shandong Provincial Hospital Affiliated to Shandong University from January 1st, 2017 to June 30th, 2017 were enrolled. According to postoperative pathological results, 250 patients were diagnosed of benign thyroid nodules(BTN group); 77 patents were diagnosed of thyroid cancer(TC group); 54 patients had thyroid cancer with nodular goiter(TC+NG group). Two hundred healthy people were enrolled as normal control group(N group). Serum levels and positive rates of TSH, TPO-Ab and Tg-Ab were detected before surgery. Relations among serum TSH, TPO-Ab, Tg-Ab and clinicopathological features of thyroid cancer were analyzed. Risk factors of thyroid cancer were analyzed. Results    Levels of TSH, TPO-Ab and Tg-Ab in TC group and TC+NG group were significantly higher than those in N group and BTN group［2.37（1.66,3.30）, 2.26（1.55,3.28）mIU/L vs 1.96（1.41,2.55）, 1.86（1.28,2.49）mIU/L; 28.00（14.28,37.95）, 23.89（10.16,28.53）kIU/L vs 13.60（8.20,22.00）, 16.49（12.92,28.00）kIU/L; 19.25（15.00,148.79）, 19.16（10.00,186.50）kIU/L vs 13.32（9.00,36.28）, 14.24（12.74,40.17）kIU/L］; the level of TPO-Ab in BTN group was significantly higher than that in N group(all P＜0.01). Positive rates of TSH, Tg-Ab and TPO-Ab in TC group and TC+NG group were significantly higher than those in N group and BTN group(all P＜0.01); the positive rate of TPO-Ab in TC group was significantly higher than that in TC+NG group（P＜0.05). There were significant correlations of serum TSH level with gender, lesion diameter, lymph node metastasis and tumor stage(all P＜0.05). There was no correlation among TPO-Ab, Tg-Ab and clinicopathological features of tumor(P＞0.05). Multivariate logistic regression showed that elevated TSH and Tg-Ab were independent risk factors of thyroid cancer（odds ratio=2.043, 1.080; 95% confidence interval: 1.480-2.830, 1.029-1.103； P＜0.001）. Conclusions    erum levels of TSH, TPO-Ab and Tg-Ab are closely related to the occurrence and development of thyroid cancer and show great values in the differential diagnosis of benign and malignant thyroid nodules.