【摘要】 探讨降钙素 (CT)在甲状腺髓样癌 (MCT)诊断和治疗中的意义 ,并回顾分析MCT的临床特点。以手术和病理证实的 31例MTC为对象 ,起病年龄 (4 2 8± 6 7) (2 1～ 6 7)岁 ,以年龄和性别相匹配的骨质疏松症患者为对照。血清CT和甲状旁腺素采用放射免疫法检测。血钙、磷、碱性磷酸酶采用自动生化分析仪测定。 31例患者中男性 19例 ,女性 12例 ;散发型 2 2例 (71% ) ,合并多发性内分泌腺瘤病 (MEN) 9例 (2 9% ) ;多于中青年起病。首发症状主要是逐渐长大的颈前肿物 ,临床症状为不同程度的消耗症状、腹泻、腹痛、多汗、声音改变等。合并MEN的尚有高儿茶酚胺的表现。甲状腺均触及肿大 ,质硬、活动度差 ,7例有颈淋巴结肿大。患者人均手术 (1 4± 0 7) (1～ 4 )次 ,病理以甲状腺滤泡旁细胞增生为特点 ,降钙素免疫组织化学染色均阳性 (6例 ,10 0 % )。肿瘤易于复发 (4 1 9% )和转移(5 4 8% )。术前和复发时CT水平为 (14 6 5 2 3± 1314 0 1)ng/L ,明显高于正常和骨质疏松对照组 (P <0 0 0 1) ,术后为(388 99± 374 95 )ng/L ,明显低于术前水平 (P <0 0 1) ,CT与血钙、磷无明显相关性。对于逐渐增大、质硬、伴颈淋巴结肿大的甲状腺肿物 ,应谨惕MCT的可能。血清CT是敏感而特异的MCT标志物 ,对于MCT的早期诊断、更多还原

【Abstract】 To explore the value of serum calcitonin (CT) level in diagnosis and treatment of medullary carcinoma of thyroid (MCT), to analyze the characters of MCT. Thirty-one MCT cases confirmed by operation and pathology were studied. The age was 48.9±12.9(x—±s,the range of age:24～69 years). The control group included osteoporosis cases with same age range and gender. CT and parathyroid hormone levels were detected by radioimmunoassay. Calcium, phosphate and alkaline phosphatase concentrations were biochemically examined. 19 male and 12 famale were diagnosed as MCT. 22 (71%) cases were sporadic, and 9(29%) were complicated with multiple endocrine neoplasia type 2 (MEN). The main primary signs were enlarged thyroid mass. The cases with MEN showed high catecholamine signs.Enlarged, hard thyroids were found in all cases, and cervical lymphnodes were enlarged in 7 cases. The operation times were (1.4±0.7)(1～4)times/case. The pathology characters were thyroid C-cell hyperplasia and positive calcitonin stain (6 cases,100%). MCT was easy to recur(41.9%)and metastasize (54.8%). Serum CT level of pretreatment and recurrence was (1465.23±1314.01)ng/L,significant higher than normal range and control group(P<0.001), and CT level was (388.99±374.95)ng/L after operation, obviously lower than preoperation(P<0.01). Serum CT is a sensitive and specific marker of MCT, potentially to support early diagnosis and to estimate the operation effect and tumor recurrence.更多还原