CEUS定量分析联合血清uPA、Hpa检测在甲状腺结节性质判断中的价值
摘要
目的探讨超声造影(CEUS)定量分析联合血清乙酰肝素酶(Hpa)、尿激酶纤溶酶原激活物(uPA)检测在甲状腺结节性质判断中的价值。方法选取300例甲状腺结节患者,在常规超声检测的基础上进行CEUS定量分析,并检测血清uPA、Hpa,以穿刺活检或术后病理检查结果为金标准,比较良性和恶性结节的特征差异。以CEUS定量分析、血清uPA、血清Hpa中任意两项指标检测阳性为联合诊断阳性,比较单项诊断、联合诊断的灵敏度、特异度、受试者工作特征(ROC)曲线下面积(AUC)。结果 300例甲状腺结节患者共检出324枚结节,经病理检查236枚(220例患者)为良性(良性组),88枚(80例患者)为恶性(恶性组)。恶性组在常规超声中多表现为边界不清晰、形态不规则,内部回声不均匀,CEUS检测中多表现为不均匀低增强;良性组在常规超声中多表现为边界清晰、内部回声均匀,CEUS检测多表现为均匀高增强或周边环形高增强。良性组和恶性组的二维声像特征CEUS增强模式上差异有统计学意义(P均<0.05)。在CEUS时间-强度曲线中,恶性组峰值强度、AUC低于良性组(P均<0.05),达峰时间长于良性组(P<0.05),两组渡越时间比较差异无统计学意义(P>0.05);CEUS定量分析的灵敏度为79.54%,特异度为89.41%。恶性组血清uPA、Hpa水平均高于良性组(P均<0.05)。血清Hpa检测的临界值为56.24 U/mL,其灵敏度和特异度分别为73.86%、85.17%,uPA单项检测的临界值为1 036.75 pg/mL,灵敏度和特异度分别为70.45%、86.86%。CEUS定量分析联合血清uPA、Hpa检测的灵敏度为90.90%,高于单项检测(P<0.05),特异度为80.09%,与单项检测比较差异无统计学意义。CEUS定量分析联合血清uPA、Hpa判断甲状腺结节性质的AUC为0.906,高于单项检测(P均<0.05)。结论 CEUS定量分析联合血清uPA、Hpa有助于甲状腺结节性质判断,诊断效能较高。
引文
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[12] Gondi CS,Lakka SS,Yanamandra N,et al.Expression ofantisense uPAR and antisense uPA from a bicistronic adenoviral construct inhibits glioma cell invasion,tumor growth,and angiogenesis[J].Oncogene,2003,22(38):5967-5975.
[13] Higashi N,Waki M,Sue M,et al.Heparanase-mediated cleavage of macromolecular heparin accelerates release of granular components of mast cells from extracellular matrices[J].Biochem J,2014,458(2):291-299.
[14] 李建业,鲁凯,姚壮凯,等.Hpa、uPA在分化型甲状腺癌组织中表达的临床意义[J].中华内分泌外科杂志,2015,9(3):235-237.
[15] Sasaki H,Klotz LH,Sugar LM,et al.A combination of desmopressin and docetaxel inhibit cell proliferation and invasion mediated by urokinase-type plasminogen activator (uPA) in human prostate cancer cells[J].Biochem Biophys Res Commun,2015,464(3):848-854.
[16] 李建业,鲁凯,姚壮凯,等.甲状腺癌患者血清Hpa、uPA检测及其临床意义[J].海南医学,2015,26(4):532-534.
[17] 何颖,杨美玉,匡莉,等.超声检查联合基质金属蛋白酶检测对甲状腺癌的诊断价值[J].现代肿瘤医学,2017,25(2):279-282.
[2] 李建业,鲁凯,姚壮,等.乙酰肝素酶在甲状腺乳头状癌患者组织及血清中表达的临床意义[J].中华内分泌外科杂志,2016,10(4):303-306.
[3] 李小毅.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:外科部分[J].中国癌症杂志,2016,26(1):13-18.
[4] Bahl M,Sosa JA,Nelson RC,et al.Trends in incidentally identified thyroid cancels over a decade:A retrospective analysis of 2090 surgical patients[J].World J Surg,2014,38(6):1312-1317.
[5] Spielamn DB,Badhey A,Kadakia S,et al.Rare Thyroid Malignancies:an Overview for the Oncologist[J].Clin Oncol-UK,2017,29(5):298-306.
[6] 吴昌财,朱凌源,陈文,等.超声造影定量分析对甲状腺实性结节血流灌注异质性的评价[J].中华医学杂志,2015,95(43):3519-3522.
[7] 尚钐钐,马秀梅.乙酰肝素酶非酶活性促进肿瘤侵袭转移的研究进展[J].临床与实验病理学杂志,2015,31(9):1031-1033.
[8] Ma JJ,Ding H,Xu BH,et al.Diagnostic performances of various gray-scale,color doppler,and contrast-enhanced ultrasonography findings in predicting malignant thyroid nodules[J].Thyroid,2014,24(2):355-363.
[9] Jiang J,Shang X,Zhang H,et al.Correlation between maximum intensity and microvessel density for differentiation of malignant from benign thyroid nodules on contrast-enhanced sonography[J].J Ultrasound Med,2014,33(7):1257-1263.
[10] 费腾,陈亚青.甲状腺癌超声诊断的研究进展[J].中国癌症杂志,2015,25(4):316-320.
[11] 刘春,葛倩.血清MUC 1和Hpa检测对甲状腺乳头状癌及淋巴转移的诊断价值[J].贵阳医学院学报,2015,40(12):1370-1373.
[12] Gondi CS,Lakka SS,Yanamandra N,et al.Expression ofantisense uPAR and antisense uPA from a bicistronic adenoviral construct inhibits glioma cell invasion,tumor growth,and angiogenesis[J].Oncogene,2003,22(38):5967-5975.
[13] Higashi N,Waki M,Sue M,et al.Heparanase-mediated cleavage of macromolecular heparin accelerates release of granular components of mast cells from extracellular matrices[J].Biochem J,2014,458(2):291-299.
[14] 李建业,鲁凯,姚壮凯,等.Hpa、uPA在分化型甲状腺癌组织中表达的临床意义[J].中华内分泌外科杂志,2015,9(3):235-237.
[15] Sasaki H,Klotz LH,Sugar LM,et al.A combination of desmopressin and docetaxel inhibit cell proliferation and invasion mediated by urokinase-type plasminogen activator (uPA) in human prostate cancer cells[J].Biochem Biophys Res Commun,2015,464(3):848-854.
[16] 李建业,鲁凯,姚壮凯,等.甲状腺癌患者血清Hpa、uPA检测及其临床意义[J].海南医学,2015,26(4):532-534.
[17] 何颖,杨美玉,匡莉,等.超声检查联合基质金属蛋白酶检测对甲状腺癌的诊断价值[J].现代肿瘤医学,2017,25(2):279-282.