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原来你是这样的甲状腺肿瘤标志物！

2018-03-02 左铎 检验医学网

甲状腺肿瘤检验标志物
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随着城市建设的步伐加快，很多都市白领感觉工作压力大，同时，甲状腺疾病患者也开始出现年轻化的趋势，甚至有人正值青春年华就得了甲状腺癌。甲状腺癌患者可能都有个疑问，手术治疗后血清甲状腺球蛋白（Tg）升高是不是表示会有复发的风险呢？


作者：天津医科大学肿瘤医院检验科  左铎

随着城市建设的步伐加快，很多都市白领感觉工作压力大，同时，甲状腺疾病患者也开始出现年轻化的趋势，甚至有人正值青春年华就得了甲状腺癌。甲状腺癌患者可能都有个疑问，手术治疗后血清甲状腺球蛋白（Tg）升高是不是表示会有复发的风险呢？

虽然血清Tg检测不能用于鉴别甲状腺结节的良恶性，但是可用于分化型甲状腺癌（DTC）患者术前的初次评估，此时血清Tg与血清甲状腺球蛋白抗体（TgAb）同时检测结果可作为术后评估的基础参考值，而Tg和TgAb作为甲状腺癌血清标志物最主要的价值还是用于术后的监测和管理。

去年国内首部《甲状腺癌血清标志物临床应用专家共识》给出了详细的术后评估和管理标准：对于DTC患者进行全切除术后和（/或）接受放射性碘-131（131I）清除术后，需要注意定期进行随访血清Tg水平的变化，同时需要检测TgAb的水平。一般术后一个月后进行初次评估，此时患者血清促甲状腺激素（TSH）受到抑制，处于很低的水平，术后血清Tg＜1.0ng/ml并且血清TgAb为阴性时，说明患者治疗生化反应良好。如果在术后几个月的动态监测过程中，发现患者血清Tg水平有明显升高或逐渐升高，有肿瘤复发或转移的可能性极大，需要进一步检查和治疗。

但是值得注意的是，如果血清TgAb水平同时升高，难免会影响血清Tg的水平，这时通过血清Tg水平来评估是否有残留或复发转移的可能会有偏差，建议结合影像等其他检查手段综合评估。

在患者接受检查过程中，医生会要求患者术前和术后在同一家医院进行监测血清Tg和TgAb水平，便于有效地合理评估血清标志物的动态水平。如果这家医院检验科具有高灵敏的检测技术（高敏免疫检测法的功能灵敏度Tg≤0.1ng/ml），那么通过监测血清Tg水平更能帮助医生判断DTC患者是否可以接受左旋甲状腺制剂（LT4）替代治疗或TSH抑制性治疗。

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    2018-03-26 hukaixun

    #标志物#

    0

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    2018-03-19 vera_1213

    #甲状腺肿#

    0

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    2018-09-22 smartjoy

    #甲状腺肿瘤#

    0

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    2018-03-03 半夏微凉

    学习了谢谢分享

    0

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    2018-03-03 飛歌

    学习了很有用不错

    0