| Objective: To detect the serum TK1(thymidine kinase 1,TK1)in patients with thyroid nodules,and investigate the diagnostic value of combined serum TK1,TSH,Tg and Anti-tg in differentiating benign and malignant thyroid nodules,and analyze the relationship between serum TK1,TSH,Tg and Anti-Tg in patients with thyroid nodules and their clinicopathological characteristics.Methods: retrospective analysis was used in this study to select the case data of patients with newly treated thyroid nodules who underwent thyroid surgery in the head and neck surgery department of sichuan cancer hospital from May 2018 to September 2019.According to the inclusion criteria and exclusion criteria,a total of 433 patients were included in the study.Pathological results were used as the gold standard for diagnosis,among which 155 patients had benign nodules and 278 had malignant nodules.The age,gender and other general clinical data of the two groups of patients as well as the expression levels of serum TK1,TSH,Tg and Anti-Tg in the two groups were analyzed.To investigate the relationship between serum TK1,TSH,Tg and Anti-Tg levels in patients with malignant thyroid nodules and their clinicalopathological characteristics.ROC curve analysis and Logistic regression analysis were used to evaluate the diagnostic value of serum TK1,TSH,Tg and Anti-Tg in differentiating benign and malignant thyroid nodules.Statistical software SPSS20.0 was used to process the data in this study,chi-square test was used for qualitative data comparison between groups,and independent sample t test or rank sum test was used for quantitative data comparison between groups.The test level was =0.05,and the difference was considered statistically significant when P<0.05.Results:1.Comparison of general data: the age of patients in the malignant thyroid nodules group was 41.79±11.49 years old,and the age was less than 51.08±11.28 years old in the benign thyroid nodules group,with statistically significant difference(P<0.001).The glucose level of patients in the malignant thyroid nodules group was 4.95±0.71 mmol/L,while that in the benign thyroid nodules group was 5.24± 0.79 mmol /L,with statistically significant differences(P<0.001).There was no significant difference in gender composition and serum ALT between the two groups.FT3 and FT4 levels in the malignant thyroid nodules group were2.85±0.41 pg/ml and 1.12±0.25 ng/dl,respectively;FT3 and FT4 levels in the benign thyroid nodules group were 2.92±0.40 pg/ml and 1.13±0.19ng/dl,respectively,with no statistically significant difference between the two groups.The TK1,TSH and anti-tg levels of patients in the malignant thyroid nodules group were 2.31(1.94,2.92)pmol/L,2.42(1.61,3.39)m IU/L and 14.69(10.25,76.06)IU/ml,higher than those in the benign nodules group(1.53(1.12,1.94)pmol/L,1.60(1.00,2.83)m IU/L and10.76(8.02,16.48)IU/ml,However,the serum Tg level of 9.40(2.46,29.55)ng/ml in the malignant nodules group was lower than 38.47(10.51,121.70)ng/ml in the benign nodules group(P < 0.001).2.The sensitivity,specificity and AUC(Area under ROC curve)of single detection of serum TK1 level for benign and malignant differentiation of thyroid nodules were 0.730,0.819 and 0.798,respectively.The sensitivity,specificity and AUC of TSH were 0.838,0.432 and 0.644 respectively.The sensitivity,specificity and AUC of serum Tg were 0.709,0.619 and 0.695 respectively.The sensitivity,specificity and AUC of detecting serum Anti-Tg for benign and malignant thyroid nodules were 0.662,0.574 and 0.651,respectively.The cut-off values of serum TK1,TSH,Tg and Anti-tg were 2.005pmol/L,1.387 m IU/L,22.525ng/ml and 11.400IU/ ml,respectively.The AUC of TK1 is higher than that of TSH,Tg and Anti-Tg.The cut-off value of TK1,TSH,Tg and Anti-tg was 0.660,and the AUC was 0.820,all higher than each other.3.In the thyroid malignant nodules group,the serum TK1 level of the patients with capsular invasion was 2.40(2.01,3.07)pmol/L,while the serum TK1 level of the patients without capsular invasion was 2.20 (1.84,2.78)pmol/L,and the serum TK1 level of the patients with capsular invasion was higher than that of patients without capsular invasion(P =0.049).4.In the thyroid malignant nodules group,the Tg level of patients with the largest tumor diameter ? 1cm was 7.49(1.67,19.43)ng/ml,and the Tg level of patients with the largest tumor diameter > 1cm was 19.98(4.19,89.43)ng/ml.Tg levels in patients with maximum tumor diameter > 1cm were higher than those with maximum tumor diameter ?1cm(P < 0.001).Serum Tg level was not associated with invasion of capsule,metastasis of lymph node,number of lesions and TNM stage.5.In the thyroid malignant nodules group,the serum TSH and Anti-Tg levels of the patients had no correlation with the maximum tumor diameter,the number of lesions,whether the capsule was invaded,whether the lymph node was metastatic or not and the TNM stage.Conclusion:Single detection of serum TK1 level has a certain diagnostic efficacy in differentiating benign and malignant thyroid nodules,and the increase of TK1 level may indicate the invasion of the capsule of thyroid malignant tumor and lymph node metastasis.The detection of TK1 combined with serum TSH,Tg and Anti-Tg can further improve the diagnostic efficiency of differentiating benign and malignant thyroid nodules,and has certain reference value in clinical work. |
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