摘要
目的探讨肿瘤标志物降钙素(CT)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、胃泌素释放肽前体(Pro-GRP)和嗜铬粒蛋白A(CgA)在鉴别甲状腺髓样癌(medullary thyroid carcinoma,MTC)的应用价值。方法回顾性选取2017年2月至2019年8月复旦大学附属肿瘤医院检验科检测的105例甲状腺髓样癌(MTC),50例甲状腺乳头状癌,10例甲状腺滤泡癌,5例甲状腺未分化癌,50例甲状腺良性疾病,30例非甲状腺恶性肿瘤以及50例健康对照血清CT含量。选取其中79例MTC,30例非MTC甲状腺恶性肿瘤及30例健康对照者,检测血清CEA、NSE、Pro-GRP和CgA含量。利用受试者工作曲线明确各指标区分不同组之间的曲线下面积(AUC)、敏感度和特异度。结果MTC患者CT含量的中位数为607.2(152.5,2777.5)pg/ml,较甲状腺乳头状癌患者1.48(0.5,2.91)pg/ml、甲状腺滤泡癌患者1.90(0.82,2.99)pg/ml、甲状腺未分化癌患者0.50(0.50,4.93)pg/ml、甲状腺良性疾病患者1.30(0.50,2.79)pg/ml、非甲状腺恶性肿瘤患者1.36(0.50,2.89)pg/ml及健康人群2.05(0.89,3.18)pg/ml均显著升高。CT鉴别诊断MTC与非MTC患者的敏感度为96.2%,特异度为99.3%,AUC为0.99。MTC结节最大直径(>1 cm,P=0.001,OR=15.74)与MTC结节个数(>1个,P=0.04,OR=3.4)是CT升高的两个独立危险因素。CEA(AUC=0.94)、NSE(AUC=0.65)、Pro-GRP(AUC=0.94)以及CgA(AUC=0.83)均能够区分MTC与非MTC甲状腺恶性肿瘤。联合CT、CEA、NSE、Pro-GRP和CgA区分MTC与非MTC甲状腺恶性肿瘤的的AUC为1,敏感度是100%,特异度是100%。结论CT、CEA、NSE、Pro-GRP和CgA对于MTC的辅助诊断可能具有重要意义,联合这些指标诊断MTC具有较高的敏感度和特异度。
Objective To discuss the diagnostic value of calcitonin(CT),carcinoembryonic antigen(CEA),neuron-specific enolase(NSE),pro-gastrin releasing peptide(Pro-GRP)and chromogranin A(CgA)in the identification of medullary thyroid carcinoma(MTC).Methods The CT levels in 105 cases of MTC,50 cases of papillary thyroid carcinoma,10 cases of thyroid follicular carcinoma,5 cases of undifferentiated thyroid carcinoma,50 cases of benign thyroid diseases,30 cases of non-thyroid malignant tumors and 50 cases of healthy controls were measured from February 2017 to August 2019 at the Department of Clinical Laboratory,Cancer Hospital affliated to Fudan University.Additionally,79 cases of MTC,30 cases of non-MTC thyroid malignant tumors and 30 healthy controls were selected for the measurement of CEA,NSE,Pro-GRP and CgA levels.The receiver operating curve was utilized to clarify the area under the curve(AUC),sensitivity,and specificity of each indicator to distinguish between different groups.Results The medians of CT concentrations in the group of MTC patients was 607.2(152.5,2777.5)pg/ml,which was statistically significantly higher than that of the subjects in the group of papillary thyroid carcinoma 1.48(0.5,2.91)pg/ml,follicular thyroid carcinoma 1.90(0.82,2.99)pg/ml,undifferentiated thyroid carcinoma 0.50(0.50,4.93)pg/ml,benign thyroid disease 1.30(0.50,2.79)pg/ml,non-thyroid malignancies 1.36(0.50,2.89)pg/ml and healthy controls 2.05(0.89,3.18)pg/ml.The sensitivity,specificity and AUC of CT to distinguish MTC vs.non-MTC patients was 96.2%,99.3%and 0.99,respectively.The maximum diameter(>1 cm,P=0.001,OR=15.74)and number(>1,P=0.04,OR=3.4)of nodules were two independent risk factors for elevated CT.CEA(AUC=0.94),NSE(AUC=0.65),Pro-GRP(AUC=0.94)and CgA(AUC=0.83)could all distinguish MTC vs.non-MTC thyroid malignancies.The AUC,sensitivity and specificity by combining CT,CEA,NSE,Pro-GRP and CgA to differentiate MTC vs.non-MTC thyroid malignancies was 1,100%and 100%,respectively.Conclusions CT,CEA,NSE,Pro-GRP and CgA may be helpful for the auxiliary diagnosis of MTC.The combination of these indicators in the diagnosis of MTC has high sensitivity and specificity.
作者
韩筱点
卢仁泉
胡昊昀
郭林
Han Xiaodian;Lu Renquan;Hu Haoyun;Guo Lin(Department of Clinical Laboratory,Shanghai Cancer Center,Fudan University,Shanghai 200032,China;Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2021年第12期1468-1474,共7页
Chinese Journal of Preventive Medicine
基金
国家自然科学基金(81772808,81772774,82072876)。
