彩色多普勒超声联合血清P53、midkine、S-TK1鉴别甲状腺结节良恶性的临床价值研究

摘要 目的：研究彩色多普勒超声联合血清P53、midkine及胸苷激酶1（S-TK1）鉴别甲状腺结节良恶性的临床价值。方法：将2015年1月～2020年1月我院收治的420例甲状腺结节患者纳入研究。将其按照术后病理学检查结果的不同分成恶性结节组150例与良性结节组270例。比较两组各项超声图像特征，血清P53、midkine及S-TK1水平。以受试者工作特征（ROC）曲线分析彩色多普勒超声联合血清P53、midkine、S-TK1或以上方式单独检测诊断甲状腺恶性结节的能效。结果：恶性结节组超声图像特征中形态不规则，边界不清晰，无包膜，内部钙化以及血流分级为2～3级人数占比均高于良性结节组（P＜0.05）。恶性结节组血清P53、midkine及S-TK1水平均高于良性结节组（P＜0.05）。经ROC曲线分析可得：彩色多普勒超声联合血清P53、midkine、S-TK1诊断甲状腺恶性结节的曲线下面积为0.895、灵敏度为0.92以及特异度为0.88均高于上述方式单独检测。结论：彩色多普勒超声联合血清P53、midkine及S-TK1鉴别甲状腺结节良恶性的临床价值较高。

Clinical Value of Color Doppler Ultrasound Combined with Serum P53, Midkine and S-TK1 to Identify Benign and Malignant Thyroid Nodules

ABSTRACT Objective: To study the clinical value of color doppler ultrasound combined with serum P53, midkine and thymidine kinase 1 (S-TK1) in differentiating benign and malignant thyroid nodules. Methods: 420 patients with thyroid nodules who were admitted to our hospital from January 2015 to January 2020 were included in the study. The patients were divided into 150 malignant nodules group and 270 benign nodules group according to the different results of postoperative pathological examination. The various ultrasound image characteristics and levels of P53, midkine and S-TK1 were compared between the two groups. In addition, the receiver operating characteristic curve (ROC) was used to analyze the energy efficiency of color doppler ultrasound and the diagnosis of thyroid malignant nodules at the level of serum P53, midkine, S-TK1 or above. Results: In the ultrasonic image features of the malignant nodules group, the proportion of shape irregularity, unclear boundary, no capsule, internal calcification and the blood flow grade of grade 2 to 3 were higher than those of the benign nodules group (P<0.05). The levels of P53, midkine and S-TK1 in the malignant nodule group were higher than those in the benign nodule group (P<0.05). According to ROC curve analysis, the area under the curve, sensitivity and specificity of the diagnosis of thyroid malignant nodules by color doppler ultrasound combined with serum P53, midkine and S-TK1 were 0.895, 0.92 and 0.88 respectively, which were all higher than those detected by the above method alone. Conclusion: Color doppler ultrasound combined with serum P53, midkine and S-TK1 has a high clinical value in differentiating benign and malignant thyroid nodules.