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摘要：
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目的:探讨多模态超声定量分析联合血清促甲状腺激素(TSH)、促甲状腺激素受体抗体(TRAb)在甲状腺结节良恶性诊断中的价值。方法:选取2020年1月至2021年12月于我院就诊的甲状腺结节性疾病患者300例作为研究对象。电化学发光法检测研究对象血清TSH、TRAb水平;受试者工资特征(ROC)曲线分析血清TSH、TRAb对良恶性甲状腺结节的临床诊断价值;以病理诊断为金标准,比较超声造影、实时剪切波弹性成像(SWE)、AI常规超声及多模态超声的诊断效能,评价多模态超声联合血清TSH、TRAb对甲状腺结节良恶性的诊断效能。结果:入组患者中发现结节339个,术后病理诊断结果显示共有142个恶性结节,均为甲状腺乳头状癌;197个良性结节,包括甲状腺腺瘤48个,结节性甲状腺肿124个,桥本甲状腺炎25个。多模态超声检查的灵敏度为85.21%,特异度为82.23%,准确度为83.48%,诊断效能均高于AI常规超声、超声造影和SWE检查方法。与甲状腺良性结节患者比较,恶性结节患者血清TSH、TRAb表达水平显著增高,差异有统计学意义(P<0.05)。血清TSH诊断甲状腺结节良恶性的曲线下面积为0.770(95%CI 0.721~0.814),灵敏度为65.49%,特异度为81.73%,截断值为4.78 mIU·L-1;血清TRAb诊断甲状腺结节良恶性的曲线下面积为0.819(95%CI 0.773~0.858),灵敏度为60.56%,特异度为87.82%,截断值为4.03 IU·L-1。多模态超声与血清TSH、TRAb联合诊断甲状腺结节良恶性的灵敏度为97.18%,特异度为81.73%,准确度为88.20%,Kappa值为0.765,其诊断效能显著高于多模态超声和血清TSH、TRAb单独检测。结论:多模态超声联合血清TSH、TRAb在鉴定甲状腺结节良恶性中有一定临床应用价值。 |
Objective: To investigate the value of multimodal ultrasound quantitative analysis combined with serum thyroid stimulating hormone(TSH) and thyrotropin receptor antibody(TRAb) in the diagnosis of benign and malignant thyroid nodules. Methods: From January 2020 to December 2021, 300 patients with thyroid nodule disease were treated in our hospital.Serum TSH and TRAb levels were detected by electrochemiluminescence method. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of serum TSH and TRAb in benign and malignant thyroid nodules. Using pathological diagnosis as the gold standard, the diagnostic efficacy of contrast-enhanced ultrasound, real-time shear wave elastography(SWE), AI conventional ultrasound and multimodal ultrasound were compared,the diagnostic efficacy of multimodal ultrasound combined with serum TSH and TRAb in benign and malignant thyroid nodules was evaluated. Results: There were 339 nodules in 300 patients. Postoperative pathological diagnosis showed 142 malignant nodules(all papillary thyroid carcinoma), 197 benign nodules(including 48 thyroid adenomas, 124 nodular goiters, and 25 Hashimoto's thyroiditis). The sensitivity, specificity and accuracy of multimodal ultrasound were 85.21%, 82.23% and 83.48% respectively, the diagnostic efficacy of multimodal ultrasound was higher than that of AI conventional ultrasound, contrast-enhanced ultrasound and SWE.Compared with patients with benign thyroid nodules, patients with malignant thyroid nodules had greatly higher expression levels of serum TSH and TRAb(P<0.05).The area under the curve of serum TSH in diagnosing benign and malignant thyroid nodules was 0.770(95%CI 0.721-0.814), the sensitivity was 65.49%, the specificity was 81.73%, and the cut-off value was 4.78 mIU·L-1;the area under the curve of serum TRAb in diagnosing benign and malignant thyroid nodules was 0.819(95%CI 0.773-0.858), the sensitivity was 60.56%, the specificity was 87.82%, and the cut-off value was 4.03 IU·L-1.The sensitivity, specificity, and accuracy of the combination of multimodal ultrasound, serum TSH, and TRAb in the diagnosis of benign and malignant thyroid nodules were 97.18%, 81.73%, and 88.20%, respectively, the Kappa value was 0.765, the diagnostic efficacy of the combination was greatly higher than that of multimodal ultrasound, serum TSH, and TRAb alone. Conclusion: Multimodal ultrasound combined with serum TSH and TRAb has certain clinical value in the identification of benign and malignant thyroid nodules. |
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