CK-19、Tg及HBME-1在甲状腺结节患者中的表达水平及联合检测的临床应用价值

摘要

Objective To investigate the pre-and post-operation changes of thyroglobulin(Tg) levels and the expression levels of CK-19 and HBME-1, exploring their clinical values in the diagnosis and prognosis estimation of thyroid nodules.Methods EnVision immunohistochemical technique was used to detect the expression of CK-19 and HBME-1 in 153 thyroid lesions.The same patients were enrolled to measure the pre-and post-operation changes of Tg levels.Results The expression levels of Tg,CK-19,HBME-1 and the combined expression of CK-19 and HBME-1 are the highest in malignant nodules with metastases, the positive rate in malignant nodules were significantly higher than those in benign nodules (P<0.01).Among the three markers, CK-19 has the highest sensitivity, while HBME-1 has the highest specificity and the combined detection has the highest accuracy.The recurrence rate in patients with increased or similar post-operative Tg value compared with pre-operation is significantly higher than patients with a reduced post-operative Tg value.Conclusion HBME-1 and CK-19 are two markers with high sensitivity and specificity while the combined detection can increase the accuracy of differential diagnosis, indicating the two protein markers have important diagnostic values for thyroid nodules.Also, the prognosis of malignant nodules seems poor with no decreased post-operative Tg value.%目的 探讨甲状腺结节患者术前及术后血清 Tg 值的变化及CK-19、HBME-1在甲状腺结节组织中的表达和在甲状腺结节鉴别诊断及预后评估方面的价值.方法 选择153名入院手术的甲状腺结节患者,监测其术前 3天内和手术后1月的 Tg值,并且采用免疫组化法检测结节标本中CK-19及HBME-1的表达.结果 Tg、HBME-1、CK-19及HBME-1和CK-19联合表达以恶性结节伴转移最强,恶性无转移较低,甲状腺良性结节最低,在良恶性结节中的差异具有统计学意义.各指标中CK-19的敏感性最高,HBME-1的特异性最高,HBME-1与CK-19联合检测,能提高诊断的准确度.术后Tg值高于或等于术前的患者和术后Tg值低于术前的患者之间复发率差异存在统计学意义.结论 对于甲状腺结节患者,HBME-1、CK-19的表达是具有高度敏感性和特异性的检测指标,联合检测HBME-1和CK-19有利于提高诊断的准确性,对于术前甲状腺结节的良恶性鉴别有重要的参考价值.术前用 Tg 水平来鉴别结节的良恶性意义不大,患者术前术后Tg值的变化是评估近期预后的良好指标,术后Tg值不下降常提示结节预后不良.