[血清标志物在甲状腺髓样癌中的应用]
[Application of serum markers in medullary thyroid carcinoma].
作者信息
Han X D, Lu R Q, Hu H Y, Guo L
机构信息
Department of Clinical Laboratory, Shanghai Cancer Center, Fudan University, Shanghai 200032, China Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Department of Clinical Laboratory, Shanghai Cancer Center, Fudan University, Shanghai 200032, China.
出版信息
Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Dec 6;55(12):1468-1474. doi: 10.3760/cma.j.cn112150-20210308-00229.
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). 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. The medians of CT concentrations in the group of MTC patients was 607.2 (152.5,2 777.5)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 non-MTC patients was 96.2%, 99.3% and 0.99, respectively. The maximum diameter (>1 cm, =0.001, =15.74) and number (>1, =0.04, =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 non-MTC thyroid malignancies. The AUC, sensitivity and specificity by combining CT, CEA, NSE, Pro-GRP and CgA to differentiate MTC non-MTC thyroid malignancies was 1, 100% and 100%, respectively. 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.
探讨降钙素（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）在甲状腺髓样癌（MTC）诊断中的价值。于2017年2月至2019年8月在复旦大学附属肿瘤医院临床检验科检测了105例MTC患者、50例乳头状甲状腺癌患者、10例甲状腺滤泡癌患者、5例未分化甲状腺癌患者、50例良性甲状腺疾病患者、30例非甲状腺恶性肿瘤患者及50例健康对照者的CT水平。另外，选取79例MTC患者、30例非MTC甲状腺恶性肿瘤患者及30例健康对照者检测CEA、NSE、Pro-GRP和CgA水平。采用受试者工作特征曲线来明确各指标区分不同组别的曲线下面积（AUC）、灵敏度和特异度。MTC患者组CT浓度中位数为607.2（152.5，2777.5）pg/ml，显著高于乳头状甲状腺癌组1.48（0.5，2.91）pg/ml、甲状腺滤泡癌组1.90（0.82，2.99）pg/ml、未分化甲状腺癌组0.50（0.50，4.93）pg/ml、良性甲状腺疾病组1.30（0.50，2.79）pg/ml、非甲状腺恶性肿瘤组1.36（0.50，2.89）pg/ml及健康对照组2.05（0.89，3.18）pg/ml。CT区分MTC与非MTC患者的灵敏度、特异度和AUC分别为96.2%、99.3%和0.99。结节最大径（>1 cm，P=0.001，χ²=15.74）和结节数量（>1个，P=0.04，χ²=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）和CgA（AUC=0.83）均能区分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AUC、灵敏度和特异度分别为1、100%和100%。CT、CEA、NSE、Pro-GRP和CgA可能有助于MTC的辅助诊断。这些指标联合诊断MTC具有较高的灵敏度和特异度。
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