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目的 探讨甲状腺乳头状癌(PTC)实时超声弹性成像(RTE)弹性评分及应变率比值(SR)与微血管密度(MVD)的相关性.方法 选取2016年1月至2017年12月扬州大学附属医院甲乳外科收治的54例(共58个结节)经手术病理证实为PTC的患者,所有患者术前均行RTE检查,术后行CD 34免疫组化染色和MVD计数.根据结节最大径分为≤10 mm组35个,>10 mm且≤20 mm组(15个)和>20 mm组(8个),比较各组患者弹性评分、SR及MVD的差异,对PTC弹性评分及SR、MVD进行相关性分析.结果 58个PTC结节中,54个结节弹性评分≥3分(93.1％),SR值(3.6±1.3).最大径≤10 mm组、>10 mm且≤20 mm组及>20 mm组间弹性评分及SR比较,差异无统计学意义(P>0.05).58个PTC结节中,CD 34的表达率为100％.三组结节MVD分别为(47.7±8.8)条/HP、(51.1±8.5)条/HP和(56.1±5.8)条/HP,差异有统计学意义(P<0.05).弹性评分2分、3分、4分组PTC平均MVD分别为(55.6±9.5)条/HP、(53.3±7.7)条/HP及(43.9±6.7)条/HP,不同评分PTC组间的MVD比较,差异有统计学意义(F=11.642,P=0.000),其中2分组和3分组MVD均显著高于4分组,差异有统计学意义(P<0.05),但2分组与3分组MVD间比较,差异无统计学意义(P>0.05),PTC弹性评分与MVD呈负相关,差异有统计学意义(r=-0.567,P=0.000);PTC的SR与MVD亦呈负相关,差异有统计学意义(r=-0.570,P=0.000).结论 RTE弹性评分及SR均与MVD呈负相关,RTE在PTC术前侵袭性预测及预后评估中具有潜在的临床应用价值.

Objective To investigate the correlation between elasticity score, strain ratio( SR) of real-time ultrasound elastrography ( RTE ) and microvessel density ( MVD ) in papillary thyroid carcinoma (PTC). Methods A retrospective study was performed on 54 cases(58 nodules)of patients with PTC who were admitted from January 2016 to December 2017. All patients underwent standard RTE examination pre-operatively, CD 34 immunohistochemical staining and MVD count were performed postoperatively. The nod-ules were divided into ≤10 mm,10 ～20 mm and >20 mm groups. The difference of elasticity score,SR and MVD in the three groups was compared,and the correlation between elasticity score,SR and MVD in PTC nodules was analyzed. Results Among the 58 PTC nodules,54 had elastic scores greater than or e-qual to 3 points(93. 1％),and the average SR value was(3. 6 ± 1. 3). There was no statistically significant difference between the maximum diameter ≤10 mm group,10 ～ 20 mm group and >20 mm group( P>0. 05). Among the 58 PTC nodules, the expression rate of CD 34 was 100％. Nodules of MVD in the 3 groups were(47. 7 ± 8. 8)/HP,(51. 1 ± 8. 5)/HP and(56. 1 ± 5. 8)/HP,respectively,with statistically significant differences(P<0. 05). In elastic score 2 points,3 points and 4 points PTC groups,mean MVD were (55. 6 ±9. 5)/HP,(53. 3 ± 7. 7)/HP and(43. 9 ± 6. 7)/HP,respectively. There were statistically significant difference in MVD among different score PTC groups(F =11. 642,P =0. 000). MVD in the 2 points group and 3 points group were all significantly higher than that in the 4 points group(P<0. 05), while there was no statistically significant difference in MVD between 2 points group and 3 points group (P>0. 05). PTC elastic score was negatively correlated with MVD,and the difference was statistically sig-nificant(r= -0. 567,P=0. 000);SR and MVD of PTC were also negatively correlated,with statistically significant differences(r= -0. 570,P=0. 000). Conclusion Both elasticity score and SR have signifi-cantly negative correlation with MVD in PTC nodules. RTE may have potential clinical value in predicting aggressiveness and prognosis of PTC preoperatively.