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目的 探讨血清midkine(MK)能否鉴别甲状腺结节良恶性及131I治疗前血清MK能否预测DTC患者是否存在转移灶.方法 在鉴别甲状腺结节良恶性的研究中,有162例患者(其中DTC 70例、良性甲状腺结节92例)入组,同时有75名健康者作为对照.通过ROC曲线研究术前MK和Tg水平对甲状腺结节良恶性的鉴别诊断价值.在预测是否存在转移灶的研究中,有214例DTC患者入组.通过ROC曲线研究131 I治疗前血清MK和Tg水平对是否存在摄131I转移灶的预测价值.组间比较采用两样本t检验或Mann-Whitney u检验,对MK和Tg间的相关性行Pearson分析,对无转移灶生存率采用Kaplan-Meier法进行分析.结果 Pearson分析显示MK和Tg呈显著正相关(r=0.917,P＜0.05).手术前,DTC患者血清MK和Tg水平显著高于良性甲状腺结节患者(z=-7.283和-3.191,均P＜0.05),也显著高于健康对照者(z=-7.328和-4.384,均P＜0.05).对于术前甲状腺结节良恶性的鉴别,MK的最佳切点值为323.12 ng/L,此时的诊断准确性为75.31％(122/162),高于Tg的60.49％(98/162).对于DTC的鉴别,MK和Tg的诊断准确性均为77.93％ (113/145).对于预测是否存在转移灶,Tg的最佳切点值为19.50 μg/L,诊断准确性为96.73％ (207/214);MK的最佳切点值为504.71 ng/L,诊断准确性为89.25％ (191/214).Kaplan-Meier分析显示对于DTC患者,当MK或Tg水平高于阈值(分别为500 ng/L和20μg/L)时无转移灶生存率较低于阈值时低(x2=118.539和209.823,均P＜0.05).结论 术前MK水平不但可用于鉴别甲状腺结节的良恶性,也可用来预测DTC患者是否存在转移灶,是良好的DTC血清标志物.“,”Objective To investigate values of serum midkine (MK) as a diagnostic biomarker in DTC before surgery,and as a prognostic biomarker before 131I ablation therapy.Methods A total of 162 patients (70 patients with DTC and 92 patients with benign thyroid nodules) participated in the surgical cohort,75 healthy subjects served as controls.Diagnostic values of pre-surgical MK and Tg for DTC were conducted by ROC curves.A total of 214 DTC patients participated in the 131 I treatment cohort.Prognostic values of pre-131I-ablative MK and Tg to predict 131I-avid metastases were performed by ROC curves.Independent two-sample t test or Mann-Whitney u test was used to analyze the data.The relationship between MK and Tg was analyzed by Pearson correlation analysis.Metastasis-free survival was analyzed by Kaplan-Meier method.Results MK and Tg were positively correlated (r=0.917,P＜0.05).Pre-surgical MK and Tg levels were significantly higher in DTC patients than those in benign thyroid nodule patients (z =-7.283 and-3.191,both P＜0.05) and those in controls (z=-7.328 and-4.384,both P＜0.05).The best cut-off value of MK for differentiating DTC from benign thyroid nodules was 323.12 ng/L and the diagnostic accuracy was 75.31％ (122/162),which was better than the diagnostic accuracy of Tg (60.49％,98/162).Pre-131I-ablative Tg demonstrated perfect ability to predict metastases,with cut-off value of 19.50 μg/L and diagnostic accuracy of 96.73％ (207/214).MK also performed well with cut-off value of 504.71 ng/L and diagnostic accuracy of 89.25％(191/214).DTC patients with MK or Tg levels higher than thresholds (500 ng/L,20 μg/L) showed a significantly worse 131I-avid metastasis-free survival by Kaplan-Meier analysis (x2=118.539 and 209.823,both P＜0.05).Conclusions MK can not only be used to screen DTC patients,but also be used to predict metastases before 131I ablative therapy.It is suitable to serve as a serum biomarker for DTC.