基于超声特征联合血清胱抑素对甲状腺乳头状癌的临床意义

Clinical Significance of Ultrasound Features Combined with Serum Cystatin in Papillary Thyroid Carcinoma

摘要: 目的：基于临床及超声特征表现构建列线图模型，分析超声联合血清胱抑素(Cys-C)对甲状腺乳头状癌(papillary thyroid caicinoma, PTC)的临床意义。方法：选取安徽省宿州市立医院普外三科2023年1月至2024年6月收治的经病理证实的187例PTC患者，根据术后病理报告分为LNM组和无LNM组；同时选取同期就诊于我院的125例甲状腺良性结节患者作为健康对照组。收集所有患者血清样本，采用酶联免疫吸附法检测血清HCY和Cys-C水平并记录多个超声表象包括是否存在淋巴结肿大、低回声、肿瘤数目、直径、边界不清晰、形态不规则、钙化、纵横比 ≥ 1等情况。通过单因素及多因素分析并构建临床–超声特征列线图模型，采用受试者工作特征曲线(receiver operating characteristic curve, ROC)、校准曲线及决策曲线(DCA)分析评价模型的区分度、校准度及临床实用性。结果：相较于甲状腺良性结节患者，PTC患者超声多呈现边界不清晰、形态不规则、钙化等特征，且血清Cys-C水平较低；而年龄、性别、结节直径以及HCY在两组患者中并无明显统计学差异。结论：甲状腺乳头状癌患者的超声图像多呈现为低回声、形态不规则、钙化、纵横比 ≥ 1等特征，且其血清胱抑素C水平较良性结节组降低。基于临床血清胱抑素C水平及超声特征构建的列线图模型对甲状腺乳头状癌的预测诊断具有重要的价值。

Abstract: Objective: To analyze the clinical significance of serum cystatin C (Cys-c) and ultrasound in the diagnosis of papillary thyroid carcinoma (PTC) by constructing a line diagram model based on clinical and ultrasonographic features. Methods: A total of 187 patients with pathologically confirmed PTC admitted to the Third Department of General Surgery at Suzhou Municipal Hospital in Anhui Province from January 2023 to June 2024 were selected and divided into the LNM group and non-LNM group based on postoperative pathological reports. Concurrently, 125 patients with benign thyroid nodules who were treated at our hospital during the same period were selected as the healthy control group. Serum samples were collected from all patients, and the levels of serum HCY and Cys-C were detected using enzyme-linked immunosorbent assay (ELISA). Multiple ultrasound features, including lymphadenopathy, hypoechoicity, tumor number, diameter, indistinct borders, irregular morphology, calcification, and aspect ratio ≥ 1, were recorded. Univariate and multivariate analyses were performed, and a clinical ultrasound feature column-line diagram model was constructed. The model’s discriminative power, calibration, and clinical utility were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve (DCA) analysis. Results: Compared with patients with benign thyroid nodules, PTC patients exhibited features such as indistinct borders, irregular morphology, and calcification on ultrasound, with lower serum Cys-C levels. However, there were no significant statistical differences in age, gender, nodule diameter, or HCY between the two groups. Conclusion: Ultrasound images of patients with papillary thyroid carcinoma often exhibit features such as hypoechoic, irregular morphology, calcification, and aspect ratio ≥ 1, with lower serum cystatin C levels compared to the benign nodule group. The logistic regression model constructed based on clinical serum cystatin C levels and ultrasound characteristics holds significant value for the predictive diagnosis of papillary thyroid carcinoma.