摘要
目的探讨紧密连接蛋白1(Cla-1)对甲状腺乳头状癌(PTC)的诊断临界值及联合试验诊断效能。方法以河南省平顶山市两家医院2015年1月至2020年6月收治的295例PTC和137例甲状腺良性病变(BTL)患者为对象,收集其临床和病理学资料。根据免疫组化检测结果计算Cla-1表达指数、高分子量细胞角蛋白(HMW-CK)阳性表达率和白细胞分化抗原56(CD56)缺失表达率;采用受试者工作特征(ROC)曲线确定PTC的Cla-1诊断临界值;分别以Cla-1+HMW-CK、Cla-1+CD56、HMW-CK+CD56和Cla-1+HMW-CK+CD56等组合进行串联试验,采用灵敏度、特异度和准确度评价其诊断效能。结果PTC患者年龄M(P_(25),P_(75))为48.0(41.0,55.0)岁,其中男性230例(78.0%)。BTL患者年龄M(P_(25),P_(75))为53.0(46.0,61.0)岁,其中男性34例(24.8%)。PTC和BTL患者均检测了Cla-1,检测HMW-CK者分别为198和97例,检测CD56者分别为242和136例。PTC中Cla-1表达指数M(P_(25),P_(75))为80.0%(45.0%,90.0%),高于BTL[0.0(0.0,2.0%)](P<0.001);HMW-CK阳性表达率为93.9%(186/198),BTL中均为阴性;CD56缺失表达率为89.7%(217/242),高于BTL[1.5%(2/136)](P<0.001)。Cla-1表达指数以19.0%为临界值时,诊断PTC的ROC曲线下面积(AUC)最大[AUC(95%CI):0.981(0.969,0.994)],灵敏度、特异度和准确度分别为92.2%(272/295)、98.5%(135/137)和94.2%(407/432)。各联合试验诊断PTC的灵敏度为89.3%~94.7%,特异度均为100.0%,准确度为93.1%~96.9%。结论可将Cla-1表达指数≥19.0%作为诊断PTC的临界值;Cla-1和HMW-CK(CD56)串联试验可提高诊断特异性。
Objective To explore the diagnostic cut-off value of Claudin-1(Cla-1)in papillary thyroid carcinoma(PTC)and the efficacy of the multiple test.Methods Clinical and pathological data were collected from 295 patients with PTC and 137 patients with benign thyroid lesions(BTL)admitted to two hospitals in Pingdingshan City,Henan Province from January 2015 to June 2020.The expression index of Cla-1,the positive expression rate of high molecular weight cytokeratin(HMW-CK)and the negative expression rate of leukocyte differentiation antigen 56(CD56)were calculated according to the results of immunohistochemistry.Receiver operating characteristic(ROC)curve was used to determine the cut-off value of Cla-1 for diagnosing PTC.Cla-1+HMW-CK,Cla-1+CD56,HMW-CK+CD56 and Cla-1+HMW-CK+CD56 were tested in series,and the diagnostic efficacy was evaluated by sensitivity,specificity and accuracy.Results The age of PTC patients M(P_(25),P_(75))was 48.0(41.0,55.0)years old,among which 230 cases were male(78.0%).The age of BTL patients M(P_(25),P_(75))was 53.0(46.0,61.0)years old,including 34 males(24.8%).Cla-1 detection was conducted in all PTC and BTL patients,whereas only 198 and 97 cases conducted HMW-CK detection,242 and 136 cases conducted CD56 detection,respectively.The M(P_(25),P_(75))of Cla-1 expression index in PTC was 80.0%(45.0%,90.0%),which was higher than that in BTL[0.0(0.0,2.0%)](P<0.001).The positive expression rate of HMW-CK was 93.9%(186/198)in PTC,and was negative in all BTL.The negative expression rate of D56 was 89.7%(217/242)in PTC,higher than that of BTL[1.5%(2/136)](P<0.001).When expression index 19.0%was set as the cut-off value of Cla-1 for diagnosing PTC,the area under the ROC curve(AUC)was the maximum[AUC(95%CI):0.981(0.969,0.994)],and the sensitivity,specificity and accuracy were 92.2%(272/295),98.5%(135/137)and 94.2%(407/432),respectively.In multiple tests for diagnosis of PTC,the sensitivity ranged from 89.3%to 94.7%,specificity were all 100.0%and accuracy ranged from 93.1%to 96.9%.Conclusion Cla-1 expressio
作者
侯卫东
丁红霞
李会敏
王俊宏
刘艳峰
Hou Weidong;Ding Hongxia;Li Huimin;Wang Junhong;Liu Yanfeng(Department of Endocrinology,Pingdingshan Municipal First People′s Hospital,Pingdingshan 467099,China;Department of Pathology,People′s Liberation Army Joint Logistics Support Force 989 Hospital,Pingdingshan 467099,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第28期2233-2237,共5页
National Medical Journal of China
