摘要
目的:研究单光子发射计算机断层成像术/计算机断层成像（SPECT/CT）及血清刺激状态甲状腺球蛋白（sTg）水平预测甲状腺癌术后131碘（131I）治疗患者淋巴结转移风险的价值。方法:回顾性分析2018年6月至2021年6月87例甲状腺癌术后131I治疗患者的临床资料，根据碘治疗后是否发生颈部淋巴结转移分为转移组（n=28）和未转移组（n =59）。选用SPSS 22.0统计学软件对数据进行处理，采用ROC曲线分析131I治疗首次剂量和血清sTg水平预测患者发生淋巴结转移的价值，采取非条件Logistic逐步回归分析患者发生淋巴结转移的危险因素，以一致性分析SPECT/CT联合血清sTg水平预测甲状腺癌术后131I治疗患者淋巴结转移风险的价值。P<0.05为差异有统计学意义。结果:与未转移组相比，转移组肿瘤直径>1 cm、多个病灶、双侧病灶、SPECT/CT阳性的患者比例较高，并且转移组患者sTg水平较高（P<0.05）；血清sTg≥5.268 ng/ml是甲状腺癌术后131I治疗患者发生淋巴结转移的最佳截断值（P<0.05）；肿瘤直径>1 cm、多个病灶、双侧病灶、SPECT/CT阳性、血清sTg≥5.268 ng/ml是甲状腺癌术后131I治疗患者发生淋巴结转移的危险因素（P<0.05）；SPECT/CT、血清sTg水平联合预测甲状腺癌术后131I治疗患者淋巴结转移的价值较高，敏感度为0.966、特异度为0.932。结论:甲状腺癌术后131I治疗患者发生淋巴结转移受肿瘤直径、病灶数量、病灶部位等因素影响，血清sTg≥5.268 ng/ml是患者发生淋巴结转移的最佳截断值，SPECT/CT及血清sTg联合具有较高的诊断价值。
Abstract
Objective:To investigate the value of single photon emission computed tomography (SPECT/CT) and serum stimulated state thyroglobulin (sTg) levels in predicting the risk of lymph node metastasis in patients treated with 131I after thyroid cancer surgery.Methods:The clinical data of 87 patients with thyroid cancer treated with 131I after surgery from June 2018 to June 2021 were retrospectively analyzed. According to whether cervical lymph node metastasis occurred after iodine treatment, they were divided into metastatic group (n=28) and non-metastatic group (n= 59). SPSS 22.0 statistical software was used to process the data, ROC curve was used to analyze the value of the initial dose of 131I treatment and serum sTg level in predicting the occurrence of lymph node metastasis in patients, and unconditional Logistic stepwise regression was used to analyze the risk factors for the occurrence of lymph node metastasis in patients. The value of SPECT/CT combined with serum sTg levels in predicting the risk of lymph node metastasis in patients treated with 131I after thyroid cancer surgery was analyzed with consistency. P < 0.05 was considered statistically significant.Results:Compared with the non-metastatic group, the proportion of patients with tumor diameter > 1 cm, multiple lesions, bilateral lesions, SPECT/CT positive was higher in the metastatic group, and the level of sTg was higher (P < 0.05). The serum sTg≥5.268 ng/ml was the best truncation values for lymph node metastasis in patients treated with 131I after thyroid cancer surgery (P < 0.05). Tumor diameter > 1 cm, multiple lesions, bilateral lesions, SPECT/CT positive, serum sTg≥5.268 ng/ml were risk factors for lymph node metastasis in patients treated with 131I after thyroid cancer surgery (P < 0.05). SPECT/CT combined with serum sTg level had high value in predicting lymph node metastasis in patients treated with 131I after thyroid cancer surgery, with sensitivity of 0.966 and specificity of 0.932.Conclusion:Lymph node metastasis in patients treated at 131I after thyroid cancer surgery is affected by tumor diameter, number of lesions. Serum sTg≥5.268 ng/ml is the best cut-off value for lymph node metastasis in patients, and SPECT/CT combined with serum sTg has high diagnostic value.
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