摘要
目的 研究超声及血清细胞角蛋白19(CK-19)、半乳糖凝集素3(Galectin-3)及微小核糖核酸-363(miRNA-363)联合诊断甲状腺微小乳头状癌(PTMC)颈部淋巴结转移(CLNM)的临床价值.方法 回顾性选取2021年7月至2023年6月在天津市环湖医院诊断的PTMC患者92例纳入研究组,选择同期本院收治的结节性微小甲状腺肿患者92例纳入对照组.观察两组病灶情况及超声特点;比较两组血清CK-19、Galectin-3、miRNA-363水平,研究组是否发生CLNM患者病灶超声特点及血清CK-19、Galectin-3、miRNA-363水平.分析PTMC～CLNM超声特点与血清CK-19、Galectin-3、miRNA-363水平的相关性.结果 研究组多枚病灶、病灶＞0.5 mm、病灶纵横比≥1、病灶形态不规则、病灶边缘模糊、病灶微钙化、病灶低回声、淋巴结肿大占比分别为70.65％、71.74％、82.61％、61.96％、72.83％、80.43％、84.78％、70.65％,均大于对照组(31.52％、52.17％、27.17％、25.00％、19.57％、15.22％、66.30％、22.83％),差异均有统计学意义(P＜0.05).研究组血清CK-19、Galectin-3水平分别为(30.45±3.31)、(4.68±0.48)µg/L,均高于对照组[(7.05±0.73)、(1.72±0.19)μg/L],血清 miRNA-363 水平为(2.89±0.30)fmol/L,低于对照组[(4.30±0.46)fmol/L],差异均有统计学意义(P＜0.05).研究组发生CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、病灶微钙化、淋巴结肿大占比分别为90.91％、86.36％、95.45％、100.00％、90.91％,均大于未发生CLNM患者(64.29％、54.29％、0、25.00％、64.29％),差异均有统计学意义(P＜0.05).研究组发生CLNM患者血清CK-19、Galectin-3 水平(41.20±4.42)、(5.94±0.62)μg/L,均高于未发生 CLNM 患者[(24.36±2.71)、(3.25±0.34)μg/L],血清miRNA-363水平为(2.14±0.23)fmol/L,低于未发生CLNM患者[(3.46±0.36)fmol/L],差异均有统计学意义(P＜0.05).经Pearson相关分析,CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、淋巴结肿大及血清CK-19、Galectin-3、miRNA-363 水平均与 CLNM 呈正相关(P＜0.05).结论 超声及血清 CK-19、Galectin-3、miRNA-363联合诊断PTMC～CLNM具有较高的临床价值.
Abstract
Objective To investigate the clinical value of ultrasonography combined with serum cytokeratin 19(CK-19),Galectin-3(Galectin-3)and microRNA-363(miRNA-363)in the diagnosis of cervical lymph node metastasis(CLNM)in papillary thyroid microcarci-noma(PTMC).Methods A total of 92 patients with PTMC diagnosed in Tianjin Huanhu Hospital from July 2021 to June 2023 were retrospec-tively included in the study group,and 92 patients with nodular microgoitre treated in our hospital during the same period were included in the con-trol group.Both groups were diagnosed by ultrasound and serum CK-19,galectin3 and miRNA-363.The lesions and ultrasonic characteristics of the two groups were observed.Serum CK-19,Galectin-3,and miRNA-363 levels in the two groups were compared,whether CLNM pa-tients in the study group had focal ultrasound characteristics and serum CK-19,Galectin-3,and miRNA-363 levels were compared.The correlation between the ultrasonic characteristics of PTMC-CLNM and serum levels of CK-19,Galectin-3 and miRNA-363 was analyzed.Results Multiple lesions,lesions＞0.5 mm,aspect ratio ≥ 1,irregular shape,blurred edge,microcalcification,hypoechosis,and lymph node enlargement in the study group were 70.65％,71.74％,82.61％,61.96％,72.83％,80.43％,84.78％,70.65％,which were higher than those in the control group(31.52％,52.17％,27.17％,25.00％,19.57％,15.22％,66.30％,22.83％),the differences were statistically significant(P＜0.05).Serum CK-19 and Galectin-3 levels in the study group were(30.45±3.31),(4.68±0.48)μg/L,which were higher than those in the control group[(7.05±0.73),(1.72±0.19)μg/L],and the level of serum miRNA-363 was(2.89±0.30)fmol/L,which was lower than that in the control group[(4.30±0.46)fmol/L],the differences were statistically significant(P＜0.05).In the stud-y group,the proportions of multiple lesions,irregular lesion shape,blurred lesion edges,microcalcification,and lymph node enlargement in pa-tients with CLNM were 90.91％,86.36％,95.45％,100.00％,90.91％,which were higher than those without CLNM(64.29％,54.29％,0,25.00％,64.29％),the differences were statistically significant(P＜0.05).In the study group,the levels of serum CK-19 and Galectin-3 in patients with CLNM were(41.20±4.42),(5.94±0.62)μg/L,which were higher than those without CLNM[(24.36±2.71),(3.25 ±0.34)μg/L],and the level of serum miRNA-363 was(2.14±0.23)fmol/L,which was lower than that without CLNM[(3.46±0.36)fmol/L],the differences were statistically significant(P＜0.05).According to Pearson correlation analysis,CLNM patients had positive correla-tion with multiple lesions,irregular lesion morphology,blurred lesion edges,lymph node enlargement,and serum CK-19,Galectin-3,miRNA-363 levels(P＜0.05).Conclusion Ultrasonography combined with serum CK-19,Galectin-3,miRNA-363 has high clinical value in the diagnosis of PTMC-CLNM.
基金项目
天津市自然科学基金面上项目(21JCYBJC00520)
万方数据