發(fā)布時(shí)間：2019-06-09 17:33

【摘要】：目的通過檢測(cè)TK1在離體及在體甲狀腺結(jié)節(jié)穿刺洗脫液的表達(dá)在甲狀腺良惡性結(jié)節(jié)的差異和臨床特點(diǎn)的相關(guān)性的關(guān)系,分析TK1水平檢測(cè)在甲狀腺結(jié)節(jié)良惡性鑒別中及臨床分期的意義。方法離體組選取天津醫(yī)科大學(xué)總醫(yī)院普通外科2016年5月-2016年12月間甲狀腺手術(shù)標(biāo)本,標(biāo)本離體后細(xì)針穿刺結(jié)節(jié)103枚行TK1水平檢測(cè),術(shù)后石蠟病理證實(shí)甲狀腺良性疾病的結(jié)節(jié)39個(gè),惡性結(jié)節(jié)64個(gè)。并將術(shù)后石蠟病理證實(shí)為甲狀腺乳頭狀癌著根據(jù)年齡、性別、結(jié)節(jié)大小、病灶數(shù)目、被膜情況,周圍軟組織,淋巴結(jié)轉(zhuǎn)移數(shù)目、側(cè)頸淋巴結(jié)情況進(jìn)行分組并進(jìn)行統(tǒng)計(jì)分析。在體組選取同時(shí)期在我院行甲狀腺細(xì)針穿刺檢查,穿刺病理證實(shí)良性或惡性(惡性及可疑惡性)結(jié)節(jié)42例,檢測(cè)穿刺洗脫液TK1水平。結(jié)合臨床資料,分析TK1在甲狀腺良惡性結(jié)節(jié)中表達(dá)的差異。結(jié)果離體組穿刺洗脫液中甲狀腺良性結(jié)節(jié)TK1平均濃度為(5.973±0.8779)pmol/L,惡性結(jié)節(jié)平均濃度為(8.852±0.5934)pmol/L,兩者相比差異具有統(tǒng)計(jì)學(xué)意義。結(jié)節(jié)性甲狀腺腫穿刺液TK1水平為(2.696±0.2054)pmol/L,甲狀腺腺瘤為(11.22±1.462)pmol/L,二者之間的差異具有統(tǒng)計(jì)學(xué)意義,而研究中甲狀腺腺瘤(11.22±1.462)pmol/L和甲狀腺癌(8.852±0.5934)pmol/L,TK1水平比較則沒有統(tǒng)計(jì)學(xué)意義。對(duì)結(jié)節(jié)性甲狀腺腫和甲狀腺癌結(jié)節(jié)進(jìn)行統(tǒng)計(jì)發(fā)現(xiàn)以4.225pmol/L作為截?cái)嘀?對(duì)于鑒別其性質(zhì)的敏感度和特異度為95.83%和84.38%。ROC曲線下面積為0.941。在進(jìn)行年齡、性別、結(jié)節(jié)大小、病灶數(shù)目、被膜情況組的TK1水平進(jìn)行比較發(fā)現(xiàn),差異沒有統(tǒng)計(jì)學(xué)意義,而周圍軟組織,淋巴結(jié)轉(zhuǎn)移數(shù)目、側(cè)頸淋巴結(jié)組情況的TK1水平差異具有統(tǒng)計(jì)學(xué)意義,P值均小于0.001。在體組良性結(jié)節(jié)平均濃度為(3.72±0.26)pmol/L,惡性結(jié)節(jié)平均值為(7.67±0.33)pmol/L,p0.01,差異有統(tǒng)計(jì)學(xué)意義。在體良性結(jié)節(jié)穿刺洗脫液中TK1平均濃度為(3.72±0.26)pmol/L,惡性結(jié)節(jié)穿刺洗脫液中TK1平均值為(7.67±0.33)pmol/L,差異有統(tǒng)計(jì)學(xué)意義。以4.732 pmol/L作為截?cái)嘀?計(jì)算曲線下面積為0.72,對(duì)于鑒別其性質(zhì)的敏感度和特異度為75.61%和66.29%。結(jié)論穿刺洗脫液TK1水平測(cè)定有助于在除外增生性腺瘤的甲狀腺結(jié)節(jié)性質(zhì)鑒別,對(duì)于輔助甲狀腺細(xì)針穿刺具有一定意義。穿刺洗脫液TK1水平測(cè)定有助于預(yù)測(cè)甲狀腺癌侵襲性及臨床分期,對(duì)于甲狀腺乳頭狀癌的預(yù)后評(píng)估具有一定臨床意義。
[Abstract]:Objective to detect the relationship between the expression of TK1 in thyroid nodules in vitro and in vivo and the clinical characteristics of benign and malignant thyroid nodules. To analyze the significance of TK1 level in the differential diagnosis and clinical stage of benign and malignant thyroid nodules. Methods the thyroid gland specimens from May 2016 to December 2016 were selected from the general surgery department of Tianjin Medical University General Hospital. The level of TK1 was detected by fine needle puncture nodules in vitro. 39 nodules and 64 malignant nodules in benign thyroid diseases were confirmed by paraffin pathology after operation. According to age, sex, nodular size, lesion number, capsule condition, surrounding soft tissue, number of lymph node metastasis and lateral cervical lymph node, the patients with papilla thyroid carcinoma were divided into two groups according to age, sex, nodular size, number of lesions, capsule condition, surrounding soft tissue, number of lymph node metastasis and lateral cervical lymph node. In the body group, thyroid fine needle puncture was performed in our hospital at the same time. 42 cases of benign or malignant (malignant and suspected malignant) nodules were confirmed by puncture pathology, and the TK1 level of puncture eluent was detected. Combined with clinical data, the difference of TK1 expression in benign and malignant thyroid nodules was analyzed. Results the average concentration of TK1 in benign thyroid nodules in vitro group was (5.973 鹵0.8779) pmol/L, and the average concentration of malignant nodules was (8.852 鹵0.5934) pmol/L,. There was significant difference between the two groups. The TK1 level of nodular goiter puncture fluid was (2.696 鹵0.2054) pmol/L, and that of thyroid adenoma was (11.22 鹵1.462) pmol/L, there was significant difference between the two groups. However, there was no significant difference between thyroid adenoma (11.22 鹵1.462) pmol/L and thyroid carcinoma (8.852 鹵0.5934) pmol/L,TK1. It was found that the sensitivity and specificity of 4.225pmol/L as cut-off value for distinguishing the properties of nodular goiter and thyroid carcinoma nodules were 95.83% and the area under 84.38%.ROC curve was 0.941. There was no significant difference in TK1 level between age, sex, nodular size, lesion number and capsule condition group, but the number of surrounding soft tissue and lymph node metastasis was not statistically significant. There was significant difference in TK1 level between lateral cervical lymph node group and lateral cervical lymph node group, and the P value was less than 0.001%. The average concentration of benign nodules in vivo group was (3.72 鹵0.26) pmol/L, and the average value of malignant nodules was (7.67 鹵0.33) pmol/L,p0.01,. The average concentration of TK1 in the puncture eluent of benign nodules was (3.72 鹵0.26) pmol/L, and the average concentration of TK1 in malignant nodules was (7.67 鹵0.33) pmol/L,. Using 4.732 pmol/L as cut-off value, the area under the curve was 0.72, and the sensitivity and specificity for distinguishing its properties were 75.61% and 66.29%. Conclusion the determination of TK1 level in puncture eluent is helpful to distinguish the nature of thyroid nodules except hyperplastic adenoma and has certain significance for auxiliary thyroid fine needle puncture. The determination of TK1 level in puncture eluent is helpful to predict the invasiveness and clinical stage of thyroid carcinoma, and has certain clinical significance for the prognosis evaluation of thyroid papilla carcinoma.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R581

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