赵帅华 董卫红 杨敬

【摘要】 目的 探討苦参素型锌指蛋白4（ZMAT4）、神经细胞黏附因子（NCAM）水平在甲状腺癌组织中的表达及临床意义，为指导临床早期干预提供依据。

方法 选取2018年1月～2019年12月收治的30例甲状腺癌患者作为甲状腺癌组，并选择同期甲状腺腺瘤患者30例作为甲状腺腺瘤组，两组均进行甲状腺手术治疗，术后病理组织均采用免疫组织化学染色法检测组织中ZMAT4、NCAM表达，分析ZMAT4、NCAM水平在甲状腺癌组织中的表达及临床意义。

结果 ZMAT4、NCAM在甲状腺癌组织中的阳性表达率均低于甲状腺腺瘤组织（P<0.001）;甲状腺癌组不同分期下ZMAT4、NCAM阳性表达率比较，差异均有统计学意义（P<0.05）;经logistic回归分析结果显示，ZMAT4、NCAM阳性表达率低是甲状腺癌发生的危险因素（OR>1，P<0.001）;绘制受试者工作曲线（ROC）发现，组织中ZMAT4、NCAM表达预测甲状腺癌的曲线下面积（AUC）分别为：0.800、0.783，均有一定预测价值;采用双变量Spearman直线相关性分析，结果显示，甲状腺癌患者ZMAT4与NCAM之间呈正相关（r=0.811，P<0.001）。

结论 ZMAT4、NCAM阳性表达率低可成为判断甲状腺癌发生的指标，临床可通过检测组织中ZMAT4、NCAM表达预测甲状腺癌发生、发展情况，及时采取干预措施。

【关键词】 甲状腺癌;甲状腺腺瘤;苦参素型锌指蛋白4;神经细胞黏附因子;危险因素;受试者工作曲线

中图分类号：R736.1   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.05.008

【Abstract】 Objective To investigate the expression and clinical significance of the levels of zinc finger matrin-type protein 4 （ZMAT4） and neural cell adhesion molecule （NCAM） in thyroid cancer tissues， so as to provide basis for guiding clinical early intervention.

Methods 30 patients with thyroid cancer admitted to  hospital from January 2018 to December 2019 were selected as thyroid cancer group， and 30 patients with thyroid adenoma during the same period were selected as thyroid adenoma group. Both groups were received thyroid surgery for treatment， and the expressions of ZMAT4 and NCAM in postoperative pathological tissues were all detected by immunohistochemical staining. In addition， the expression and clinical significance of ZMAT4 and NCAM levels in thyroid cancer tissues were analyzed.

Results The positive expression rates of ZMAT4 and NCAM in thyroid cancer tissues were lower than those in thyroid adenoma tissues （P < 0.001）. There was a statistically significant difference in the comparison of the positive expression rates of ZMAT4 and NCAM in different stages （P < 0.05）. Logistic regression analysis showed that the low positive expression rates of ZMAT4 and NCAM were the risk factors of thyroid cancer （OR > 1， P < 0.001）. Receiver operating curve （ROC） was drawn and found that the area under the curve （AUC） of thyroid cancer predicted by ZMAT4 and NCAM expressions in tissues were 0.800 and 0.783， respectively，  which had certain predictive value. Spearman linear correlation analysis was used， and the results of which showed that there was a positive correlation between ZMAT4 and NCAM in patients with thyroid cancer （r = 0.811， P < 0.001）.

Conclusion Low positive expression rates of ZMAT4 and NCAM can be used as indicators to judge the occurrence of thyroid cancer. The occurrence and development of thyroid cancer can be predicted by detecting the expressions of ZMAT4 and NCAM in clinic， and  timely intervention measures should be taken.

【Key words】 thyroid cancer; thyroid adenoma; ZMAT4; NCAM; risk factors; ROC

甲状腺癌为常见的甲状腺恶性肿瘤，绝大部分起源于滤泡上皮细胞，临床以甲状腺肿大为主要表现，且随病情进展，肿瘤生长可压迫食管，引发呼吸困难、吞咽障碍等并发症，甚至迅速发生转移，影响患者预后[1～2]。苦参素型锌指蛋白4（ZMAT4）广泛存在于真核生物中，可调节细胞的分化、增殖和凋亡等过程，且在细胞识别与转移等方面具有一定作用。而神经细胞黏附因子（NCAM）为免疫球蛋白超家族中的一种糖蛋白，可参与肿瘤的生长、浸润、神经再生信号的传导，在肿瘤抑制方面有一定的作用[3～4]。但目前ZMAT4、NCAM在甲状腺癌组织中表达意义的相关研究较少，故本次研究重点观察ZMAT4、NCAM在甲状腺癌和甲状腺腺瘤组织中的阳性表达情况，旨在探讨ZMAT4、NCAM在预测甲状腺癌发生的价值。……