血清TgAb水平在分化型甲状腺癌术后转移复发中的预测价值

摘要

目的:探讨完全切除甲状腺组织后血清甲状腺球蛋白(TG)阴性时,血清抗甲状腺球蛋白抗体(TgAb)对分化型甲状腺癌(DTC)术后复发/转移的预测价值.方法:选择2013年4月-2015年4月我院收治的57例完全切除甲状腺组织,TG阴性且TgAb阳性的DTC患者临床病历资料,并将其分为复发/转移组(20例)和无复发/转移组(37例).采用放射免疫分析法测定并比较两组患者的血清TG、TgAb水平,分析TgAb对DTC复发/转移诊断的灵敏度、特异度、阳性预测值以及阴性预测值,采用Logistic回归分析DTC复发/转移的独立危险因素.结果:复发/转移组的血清TgAb水平为72～3850IU/mL,高于无复发/转移组的18～3638IU/mL,差异有统计学意义(P＜0.05).其中TgAb对DTC复发/转移诊断的灵敏度为85.71％,特异度为83.33％,阳性预测值为75.00％,阴性预测值为90.91％.经Logistic回归分析发现,TgAb水平为100≤ TgAb＜204 IU/mL、204≤TgAb≤1000IU/mL、＞1000IU/mL是DTC复发/转移的独立危险因素(OR=1.267,2.853,6.791,P＜0.05).结论:TgAb可作为评估完全切除甲状腺组织、TG阴性且TgAb阳性的DTC患者复发/转移的重要指标,其值越高,复发/转移发生的可能性越大.%Objective:To explore the predictive value of serum thyroglobulin autoantibody (TgAb) for recurrence / metastasisin of thyroglobulin (TG)-negative and TgAb-positive patients with differentiated thyroid carcinoma(DTC) after thyroid ablation.Methods:The clinical data of 57 patients with DTC,undergoing complete resection of thyroid tissue,TG negative and TgAb positive,who were reviewed in Liaocheng People's Hospital during April 2013 to April 2015,were selected and divided into recurrence/metastasis group (n=20) and no recurrence/metastasis group (n=37).The TG and TgAb levels in the two groups were detected and compared by the electrochemical luminescence method,the sensitivity,specificity,positive predictive value and negative predictive value of TgAb in the diagnosis of DTC recurrence / metastasis were analyzed;the independent risk factors of DTC recurrence / metastasis were analyzed by Logistic regression.Results:The TgAb levels(72～3850 IU/mL) in the recurrence/metastasis group was higher than that(18～3638 IU/mL) in the no recurrence/metastasis group,the difference was statistically significant (P＜0.05).The sensitivity,specificity,positive predictive value,negative preictive value of TgAb in the diagnosis of recurrence/metastasis of DTC were 85.71％,83.33％,75.00％,90.91％,respectively.Logistic Regression analysis showed that the 100≤ TgAb ＜204 IU/mL,204≤ TgAb≤ 1000IU/mL,and ＞ 1000IU/rnL levels of TgAb were the independent risk factors of rucurrence/metastasis ofDTC (OR=1.267,2.853,6.791,P＜0.05).Conclusion:TgAb can be used as evaluation of an important index of the recurrence/metastasis of patients with DTC when serum thyroglobulin (TG) was negative and TgAb was positive after thyroid ablation.The higher the TgAb levels,the more probability of the recurrence/metastasis.