摘要目的:探讨超声弹性成像技术联合血清尿激酶纤溶酶原激活物（uPA）检测对甲状腺结节良恶性鉴别诊断的价值。方法:选取2018年5月至2019年5月于滨州市人民医院接受手术治疗的甲状腺微小结节（直径在0.2 ~ 2.5 cm）患者150例（共160个结节）作为观察对象。其中经术后病理确诊为良性结节患者69例（共76个良性结节，良性组），恶性结节患者81例（共84个恶性结节，恶性组）。同期选取健康体检者40例作为对照组。术前所有观察对象均进行超声弹性成像检查，以术后病理检查结果作为"金标准" ，观察超声弹性成像特征，进行评分，并与病理检查结果作比较。采用酶联免疫吸附试验（ELISA）测定血清uPA含量，比较单独超声弹性成像技术、血清uPA检测及二者联合检查诊断的灵敏度、特异度及受试者工作特征（ROC）曲线下面积（AUC）。结果:共检测150例良恶性甲状腺结节患者（共160个结节），超声弹性成像技术的灵敏度为97.37%（74/76），特异度为85.71%（72/84），准确性为91.25%（146/160），Kappa值为0.726。恶性组患者0 ~ 2分的比例显著低于良性组，3、4分的比例显著高于良性组（ P均< 0.05）。与对照组比较，良、恶性组血清uPA含量显著上升（ P均< 0.05）；与良性组比较，恶性组血清uPA含量显著上升（ P < 0.05）。联合检查的AUC为0.869，95%置信区间（ CI）为0.789 ~ 0.949，联合检查最佳截点为uPA = 982.16 mU/L，灵敏度为0.646，特异度为0.575。单独超声弹性成像技术的AUC为0.814，95% CI为0.721 ~ 0.907，联合检查的AUC高于单独超声弹性成像技术。 结论:超声弹性成像技术联合血清uPA检测对甲状腺结节良恶性鉴别诊断的临床价值高于单独超声弹性成像技术。

abstractsObjective:To investigate the value of ultrasound elastography combined with serum urokinase plasminogen activator (uPA) in differential diagnosis of benign and malignant thyroid nodules.Methods:From May 2018 to May 2019, 150 patients with thyroid nodules (160 nodules) were selected, 69 patients with benign nodules (76 benign nodules) and 81 patients with malignant nodules (84 malignant nodules) were diagnosed by postoperative pathology. In the same period, 40 healthy people underwent health examination were selected as the control group. All preoperative patients were subjected to ultrasound elastography. The results of pathological examination were diagnosed as "gold standard"; the characteristics of ultrasound elastography were observed and scored, and compared with the results of pathological examination. The level of serum uPA was measured by enzyme-linked immunosorbent assay (ELISA), the sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were compared among single real-time ultrasound elastography, serum uPA and combined diagnosis.Results:Among the 150 patients (160 nodules), for ultrasound elastography, the sensitivity was 97.37% (74/76), the specificity was 85.71% (72/84), the accuracy was 91.25% (146/160), and the Kappa value was 0.726. The ratio of 0 to 2 points in malignant group was significantly lower than that in the benign group, the ratio of 3 to 4 points was significantly higher than that in the benign group ( P < 0.05). Compared with the control group, the levels of serum uPA in the benign group and the malignant group increased significantly ( P < 0.05). Compared with the benign group, serum uPA level in the malignant group increased significantly ( P < 0.05). The AUC of combined diagnosis was 0.869, 95% confidence interval ( CI): 0.789 - 0.949, and the best cut-off point for the combined diagnosis was uPA = 982.16 mU/L, at this time, the diagnostic sensitivity was 0.646, and the diagnostic specificity was 0.575. The AUC of ultrasound elastography was 0.814, 95% CI: 0.721 - 0.907, and the AUC of combined diagnosis was higher than that of ultrasound elastography. Conclusion:The clinical value of ultrasound elastography combined with serum uPA in differentiating benign and malignant thyroid nodules is higher than that of ultrasound elastography.