血清Gal-1、sB7-H4水平对甲状腺乳头状癌患者术后转移的预测价值-东南大学学报医学版

血清Gal-1、sB7-H4水平对甲状腺乳头状癌患者术后转移的预测价值

单位：1. 十堰市国药东风总医院肿瘤科, 湖北十堰 442001;
2. 十堰市郧阳区人民医院普外一科, 湖北十堰 442500;
3. 湖北医药学院附属国药东风总医院, 湖北十堰 442000

分类号：R736.1;R446

出版年·卷·期（页码）：2025·44·第三期（419-425）

摘要：

目的: 探讨血清半乳糖凝集素-1(Gal-1)和可溶性B7-H4(sB7-H4)表达水平对甲状腺乳头状癌(PTC)患者术后转移的预测价值。方法: 选取2020年2月至2022年2月收治的126例进行甲状腺全切术+颈部淋巴结清扫术的PTC患者,根据术后病理检查是否转移分为转移组(37例)和未转移组(89例),另选取同时期体检的108例志愿者作为对照组,采用酶联免疫吸附测定(ELISA)法检测血清中Gal-1和sB7-H4水平;Spearman法分析血清中Gal-1和sB7-H4水平与PTC患者术后转移的相关性;多因素Logistic回归分析影响PTC患者术后转移的相关因素;受试者工作特征(ROC)曲线分析Gal-1和sB7-H4联合检测对PTC患者术后转移的诊断价值;采用决策曲线分析(DCA)分析血清中Gal-1和sB7-H4水平及联合检测预测PTC患者术后发生转移的临床实用性。结果: PTC患者血清中Gal-1和sB7-H4水平明显高于对照组(P<0.05);PTC患者术后转移组患者血清中Gal-1和sB7-H4水平显著高于未转移组(P<0.05);PTC患者血清中Gal-1和sB7-H4水平与PTC患者术后转移均呈正相关(r值分别为0.623、0.682,均P<0.05);血清中Gal-1和sB7-H4水平是PTC患者术后转移的危险因素(P<0.05);Gal-1和sB7-H4二者联合预测PTC患者术后转移的曲线下面积(AUC)为0.869,优于各自单独检测(Z_{二者联合-Gal-1}=2.012、Z_{二者联合-sB7-H4}=2.014,P值分别为0.044、0.044),敏感性为89.19%,特异性为69.66%;DCA结果显示,当高风险阈值为0.08~0.97时,血清Gal-1、sB7-H4联合检测预测PTC患者发生术后转移风险的净获益率优于两者单独检测,且校准曲线显示拟合效果较好,曲线斜率接近1。结论: 患者血清中Gal-1、sB7-H4水平与PTC患者术后转移密切相关,两者联合检查能够辅助临床对PTC患者术后转移进行有效预测。

Objective: To investigate the predictive value of serum levels of galectin-1(Gal-1) and soluble B7-H4(sB7-H4) in postoperative metastasis of papillary thyroid carcinoma(PTC) patients. Methods: From February 2020 to February 2022, 126 PTC patients admitted to our hospital who underwent total thyroidectomy and neck lymph node dissection were collected, and according to postoperative pathological examination for metastasis, patients were divided into metastasis group(37 cases) and non metastasis group(89 cases), 108 volunteers who entered our hospital for physical examination were included as the control group. Enzyme linked immunosorbent assay(ELISA) was applied to detect the levels of Gal-1 and sB7-H4 in serum; Spearman method was applied to analyze the correlation between serum levels of Gal-1 and sB7-H4 and postoperative metastasis in PTC patients; Relevant factors affecting postoperative metastasis in patients with PTC were analyzed by multifactorial Logistic regression; diagnostic value of combined Gal-1 and sB7-H4 assay for postoperative metastasis in PTC patients was analyzed by ROC curve; Clinical utility of serum Gal-1 and sB7-H4 levels and combined assays for predicting the development of metastases after surgery in patients with PTC was analyzed using a DCA. Results: The serum levels of Gal-1 and sB7-H4 in PTC patients were obviously higher than those in the control group(P<0.05); The serum levels of Gal-1 and sB7-H4 in PTC patients in postoperative metastasis group were obviously higher than those in the non metastasis group(P<0.05); the serum levels of Gal-1 and sB7-H4 in PTC patients were positively correlated with postoperative metastasis(r:0.623, 0.682, P<0.05); the levels of Gal-1 and sB7-H4 in serum were risk factors for postoperative metastasis in PTC patients(P<0.05); the area under the curve(AUC) of the combined prediction of Gal-1 and sB7-H4 for postoperative metastasis in PTC patients was 0.869, which was superior to their individual detection(Z_{combination-Gal-1}=2.012, Z_{combination-sB7-H4}=2.014, P:0.044, 0.044), the sensitivity was 89.19%, and the specificity was 69.66%; The results of DCA curves showed that the net benefit of the combined serum Gal-1 and sB7-H4 test in predicting the risk of postoperative metastasis in patients with PTC was superior to that of the two tests alone when the high-risk thresholds ranged from 0.08 to 0.97, and the calibration curve showed good fitting effect, with a slope close to 1. Conclusion: The serum levels of Gal-1 and sB7-H4 in patients are closely related to postoperative metastasis in PTC patients, and the combined examination of the two can assist clinical practice in effectively predicting postoperative metastasis in PTC patients.

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