【摘要】 目的探讨分化型甲状腺癌（DTC）术后首次¹³¹Ⅰ治疗前测定的刺激性甲状腺球蛋白（sTg）水平预测转移的价值。方法对101例行甲状腺全切术及颈淋巴结清扫术的DTC患者,于首次¹³¹Ⅰ治疗前1天测定sTg水平,¹³¹Ⅰ治疗后5⁷天行¹³¹Ⅰ-SPECT/CT显像。根据是否存在转移,将所有患者分为无转移（M0）组和有转移（M1）组。采用Mann-Whitney秩和检验比较两组间sTg水平,并通过ROC曲线及最佳诊断界值点（DCP）评估sTg预测DTC转移的价值;采用Kappa检验对sTg诊断结果与临床最终诊断结果行一致性检验。结果 M1组的sTg水平高于M0组,差异有统计学意义（U=328.00,P<0.001）。sTg的ROC曲线下面积为0.870,最佳DCP为40.60ng/ml,灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为72.34%（34/47）、100%（54/54）、87.13%（88/101）、100%（34/34）、80.60%（54/67）;sTg值诊断DTC转移与临床最终诊断结果一致性良好（Kappa=0.737,P<0.05）。结论首次¹³¹Ⅰ治疗前检测sTg可作为有效预测DTC转移的指标,可指导¹³¹Ⅰ的治疗剂量。更多还原

【Abstract】 Objective To investigate the value of stimulated thyroglobulin（sTg）in predicting metastasis in postoperative patients with differentiated thyroid carcinoma（DTC）before the first time ¹³¹Ⅰ ablation therapy.Methods Totally 101 patients with DTC who underwent total thyroidectomy and lymphadenectomy were included.The pre-ablation sTg level of101 patients was measured one day before first ¹³¹Ⅰ ablation therapy,and the patients underwent ¹³¹Ⅰ-SPECT/CT on 5—7days after ¹³¹Ⅰ ablation therapy.All patients were divided into M0 group and M1 group according to the presence and absence of metastases,respectively.The sTg value between the 2groups was compared by Mann-Whitney rank-suntest.The ROC curve and diagnostic critical point（DCP）were analyzed to evaluate the predictive value of sTg,and the consistency of the results in DCP and clinical final diagnosis results was analyzed with Kappatest.Results The pre-ablation sTg of M1 group were significantly higher than that of M0group（U=328.00,P<0.001）.Area under the ROC curve for sTg levels was 0.870,the DCP of sTg was 40.60ng/ml with the sensitivity of 72.34%（34/47）,specificity of 100%（54/54）,accuracy of 87.13%（88/101）,positive predictive value of 100%（34/34）,and negative predictive value of 80.60%（54/67）.The consistency of the results in DCP and clinical final diagnosis results was good（Kappa=0.737,P<0.05）.Conclusion The pre-ablation sTg is a useful diagnostic marker for predicting metastases before the first ¹³¹Ⅰ ablation therapy,which can guide the dose of ¹³¹Ⅰ ablation therapy.更多还原