目的:探讨血清肝素结合生长因子(MK)对分化型甲状腺肿瘤诊断及临床预后的评估价值。方法:选择91例分化型甲状腺肿瘤患者(DTC组)、119例甲状腺良性结节患者(良性组)和80例健康人群(对照组)作为研究对象,采用化学发光免疫分析法检测各组游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甲状腺球蛋白(Tg)水平,酶联免疫吸附法检测血清MK水平。85例DTC患者获得24个月以上随访,按照随访结果分为清甲成功且无转移病灶(预后良好组)64例和清甲成功但存在转移病灶(预后不良组)21例,分析2组患者无转移生存率,利用受试者工作曲线(ROC)研究血清Tg、MK对DTC诊断价值和转移病灶的预测价值。结果:DTC组血清Tg、MK显著高于良性组和对照组(P<0.05),良性组血清Tg显著高于对照组(P<0.05);预后不良组血清FT3、FT4、Tg、MK显著高于预后良好组(P<0.05)。在最佳临界值(Tg=25.31mg/L,MK=0.33ng/L)时,MK诊断DTC的敏感度为78.7%,特异度为81.3%,AUC为0.848(95%CI:0.791~0.905,P<0.05),MK诊断DTC的AUC高于Tg(AUC:0.787,95%CI:0.712~0.861,P<0.05);在最佳临界值(Tg=30.18mg/L,MK=0.71ng/L)时,MK预测DTC转移的敏感度为74.7%,特异度为88.3%,AUC为0.971(95%CI:0.951~0.991,P<0.05),MK预测DTC转移的AUC高于Tg(AUC:0.868,95%CI:0.811~0.925,P<0.05)。相关性分析显示,血清Tg与MK呈正相关关系(r=0.816,P<0.05),Tg与年龄呈正相关关系(r=0.913,P<0.05),MK与年龄呈正相关关系(r=0.778,P<0.05),其余各指标间均差异无统计学意义(P>0.05)。生存分析显示Tg>30.18mg/L患者24个月无转移生存率为32.7%,Tg≤30.18mg/L患者24个月无转移生存率为83.5%,差异有统计学意义(χ2=78.041,P<0.05)。MK>0.71ng/L患者24个月无转移生存率为51.2%,MK≤0.71ng/L患者24个月无转移生存率为90.6%,差异有统计学意义(χ~2=83.104,P<0.05)。结论:血清MK对DTC的诊断价值和转移病灶的预测价值均高于Tg。 Objective: To evaluate the value of serum heparin binding growth factor (MK) in the diagnosis and clinical prognosis of differentiated thyroid tumors. Methods: Ninety-one patients with differentiated thyroid tumors (DTC group), 119 patients with benign thyroid nodules (benign group) and 80 healthy people (control group) were selected as research objects. Chemiluminescent immunoassay FT3, FT4, TSH and Tg, and serum MK levels were detected by enzyme-linked immunosorbent assay. Eighty-five patients with DTC were followed up for more than 24 months. According to the follow-up results, they were divided into two groups: 64 cases with successful metastasis without metastasis (good prognosis group), 21 cases with metastasis (poor prognosis group) No metastasis survival rate, using receiver operating characteristic curve (ROC) to study the predictive value of serum Tg and MK in the diagnosis of DTC and metastatic lesions. Results: The serum Tg and MK of DTC group were significantly higher than that of benign group and control group (P <0.05), and the serum Tg of benign group was significantly higher than that of control group (P <0.05). The serum FT3, FT4, Tg and MK were significantly higher in poor prognosis group Good prognosis group (P <0.05). The sensitivity, specificity and specificity of MK in the diagnosis of DTC were 78.7%, 81.3% and 0.848 (95% CI: 0.791-0.905, respectively) at the optimal threshold (Tg = 25.31 mg / (AUC: 0.787, 95% CI: 0.712-0.861, P <0.05). The best cutoff value (Tg = 30.18mg / L, MK = 0.71ng / L ), The predictive value of MK for predicting DTC metastasis was 74.7%, specificity was 88.3%, AUC was 0.971 (95% CI: 0.951-0.991, P <0.05) , 95% CI: 0.811 ~ 0.925, P <0.05). Correlation analysis showed that there was a positive correlation between serum Tg and MK (r = 0.816, P <0.05), Tg was positively correlated with age (r = 0.913, P <0.05) <0.05). There was no significant difference between the other indexes (P> 0.05). Survival analysis showed that patients with Tg> 30.18mg / L had a non-metastatic survival rate of 32.7% at 24 months and a non-metastatic survival rate of 83.5% at 24 months after treatment with Tg≤30.18mg / L, with significant difference (χ2 = 78.041, P <0.05). The 24-month non-metastatic survival rate of MK> 0.71ng / L was 51.2%, and the non-metastatic survival rate of 24 months was MK (0.71ng / L) 90.6%, the difference was statistically significant (χ ~ 2 = 83.104, P < 0.05). Conclusion: The diagnostic value of serum MK for DTC and the predictive value of metastatic lesions are higher than Tg.