标题：超声弹性成像技术联合血清TSH检测对PTMC的诊断价值

      作者：谢丹虹，陈廷财，陈娟燕    谢丹虹，陈廷财，陈娟燕普宁市人民医院超声科，广东 普宁 515300

      卷次： 2023年34卷8期

      【摘要】 目的 研究超声弹性成像技术联合血清促甲状腺激素(TSH)检测对甲状腺微小乳头状癌(PTMC)的诊断价值。方法 选取2020年3月至2021年2月普宁市人民医院收治的50例行手术治疗的甲状腺微小结节患者作为观察组，另选取50例同期健康体检者作为对照组。两组受检者均行超声弹性成像技术检查，同时采用化学发光法(CL)检测血清TSH水平，以术后病理诊断作为金标准，采用受检者工作特征曲线(ROC)确定TSH水平最佳截点，分析超声弹性成像技术联合血清TSH诊断PTMC的敏感度、特异度，并比较所有受检者的血清TSH水平、良性和恶性结节的弹性成像评分。结果 观察组患者经术后病理检查共检出137个结节，其中良性结节80个，恶性结节57个，超声弹性成像技术检出111个结节，其中65个良性结节，46个恶性结节，检出率为81.02%，与病理结果具有较高一致性。良性结节的超声弹性成像评分为(1.47±0.11)分，明显低于恶性结节的(3.19±0.26)分，差异有统计学意义(P<0.05)；观察组中恶性结节患者的血清TSH水平为(2.91±0.24) mIU/L，良性结节患者为(2.28±0.33) mIU/L，明显高于对照组的(1.83±0.35) mIU/L，且与良性结节患者比较，恶性结节患者水平明显更高，差异均有统计学意义(P<0.05)；经ROC分析结果显示，血清TSH联合超声弹性成像检测诊断PTMC的TSH最佳截点水平为2.16 mIU/L，其曲线下面积、检测敏感度、特异度以及约登指数均明显高于单独检测，差异均有统计学意义(P<0.05)。结论 超声弹性成像技术联合血清TSH检测诊断PTMC有较高临床价值，且联合诊断的价值更高，可将其作为诊断PTMC的重要指标和技术。
      【关键词】 甲状腺微小乳头状癌；甲状腺；超声弹性成像技术；超声检查；促甲状腺激素；诊断价值
      【中图分类号】 R736.1 【文献标识码】 A 【文章编号】 1003—6350（2023）08—1152—04

Diagnostic value of ultrasound elastography combined with serum thyroid-stimulating hormone detection forpapillary thyroid microcarcinoma.
XIE Dan-hong, CHEN Ting-cai, CHEN Juan-yan. Department of Ultrasound,People's Hospital of Puning, Puning 515300, Guangdong, CHINA
【Abstract】 Objective To study the diagnostic value of ultrasound elastography combined with serum thy-roid-stimulating hormone (TSH) detection for papillary thyroid microcarcinoma (PTMC). Methods Fifty patients withthyroid nodules undergoing surgical treatment in People's Hospital of Puning from March 2020 to February 2021 wereselected as the observation group, and healthy subjects during the same period were selected as the control group. Bothgroups of subjects were examined by ultrasonic elastography and serum TSH level was detected by chemiluminescence(CL). Postoperative pathological diagnosis was regarded as the gold standard, and the working characteristic curve(ROC) of subjects was used to determine the best cutoff point of TSH level. The sensitivity and specificity of ultrasoundelastography combined with serum TSH in the diagnosis of thyroid nodules were analyzed, and the serum TSH level andelastography scores of benign and malignant nodules of all subjects were compared. Results A total of 137 noduleswere detected in the observation group through postoperative pathological examination, including 80 benign nodules and57 malignant nodules. A total of 111 nodules were detected by ultrasound elastography, including 65 benign nodules and46 malignant nodules, with the detection rate of 81.02%, which was highly consistent with the pathological results.The score of ultrasound elastography of benign nodules was (1.47±0.11) points, which was significantly lower than(3.19±0.26) points of malignant nodules (P<0.05). The serum TSH level was (2.91±0.24) mIU/L in patients with malig-nant nodules and (2.28±0.33) mIU/L in patients with benign nodules in the observation group, which were significantlyhigher than (1.83±0.35) mIU/L in subjects in the control group; the level in patients with malignant nodules was signifi-cantly higher than that in patients with benign nodules; the differences were statistically significant (P<0.05). The resultsof ROC analysis showed that the best cutoff level of TSH for the diagnosis of PTMC by serum TSH combined with ultra-sound elastography was 2.16 mIU/L, and its area under the curve, sensitivity, specificity, and Yoden index were signifi-cantly higher than those of individual detection, with statistically significant differences (P<0.05). Conclusion Ultra-sound elastography combined with serum TSH detection has a high diagnostic value for PTMC, which can be used as animportant indicator and technique to diagnose PTMC.
      【Key words】 Papillary thyroid microcarcinoma; Thyroid; Ultrasound elastography; Ultrasound; Thyroid-stimulat-ing hormone; Diagnostic value