实时剪切波弹性成像评价先天性肌性斜颈胸锁乳突肌

目的 应用实时剪切波弹性成像（SWE）技术评价先天性肌性斜颈（CMT）患儿胸锁乳突肌（SCM）。方法 对130例初诊CMT患儿进行二维超声检查,根据二维超声表现确定其二维分型（Ⅰ~Ⅳ型）,采用SWE测量患侧、健侧SCM弹性模量平均值（E_mean）;对患侧二维超声表现分型与E_mean进行相关性分析;运用ROC曲线计算各型的E_mean截断值。结果 CMT患儿各二维超声表现分型健侧与患侧SCM的E_mean差异有统计学意义（P<0.05）。各二维超声表现分型与患侧E_mean呈正相关（r_s=0.76,P<0.05）。利用ROC曲线获得Ⅰ~Ⅳ型E_mean截断值分别为15.35 kPa、29.60 kPa、38.05 kPa及47.80 kPa。结论 SWE技术可客观量化显示SCM硬度,评估CMT患儿胸锁乳突肌纤维化严重程度,具有较高临床价值。     

基于深度学习重建列表模式提取儿童18F-FDG PET/CT低剂量图像

目的 探讨基于深度学习（DL）重建列表模式提取低剂量图像用于儿童¹⁸F-FDG PET/CT检查的可行性。方法 对93例患儿行全身¹⁸F-FDG PET/CT,分别以120秒/床位行标准全剂量扫描、20秒/床位行快速扫描,之后以列表模式于120秒/床位图像中提取20秒/床位图像。将20秒/床位图像与以列表模式提取的20秒/床位图像传输至DL平台进行重建,分别获得相应全剂量图像（DL-f20s、DL-20s）;对比标准全剂量120s、DL-f20s、DL-20s图像的靶本比（TBR）、对比噪声比（CNR）、变异系数（CV）、图像质量主观评分,以及肝血池、纵隔血池、肌肉血池及原发病灶最大标准摄取值（SUV_max）和平均标准摄取值（SUV_mean）,分析基于DL-f20s与DL-20s图像所获SUV_max及SUV_mean的一致性。结果 120s、DL-f20s和DL-20s图像的主观质量Likert评分、TBR、CNR、CV及各血池、病灶的SUV_max、SUV_mean差异均无统计学意义（P均>0.05）。DL-f20s与DL-20s图像之间,5%以上肌肉血池SUV_max、SUV_mean差值在95%一致性界限（LoA）以外,其余血池及病灶的SUV_max、SUV_mean差值在95% LoA以外者均≤5%。结论 基于DL重建列表模式提取低剂量图像可用于儿童¹⁸F-FDG PET/CT检查,且所获图像的质量及代谢参数与快速扫描相当。     

基于临床、超声及基因特征列线图预测甲状腺乳头状癌侵袭性

目的 观察基于临床、超声及基因特征的列线图预测甲状腺乳头状癌(PTC)侵袭性的价值。方法 回顾性分析207例PTC患者,根据术后病理所示病灶侵及甲状腺被膜和/或发生患侧颈部淋巴结转移与否分为侵袭组(n=130)及非侵袭组(n=77);对比2组临床、超声及基因特征,筛选PTC侵袭性的危险因素,并以之建立列线图模型,观察其预测PTC侵袭性风险的价值。结果 2组患者年龄,结节最大径、与被膜直线距离、微钙化、数目和分布,以及BRAF V600E基因检测差异均有统计学意义(P均＜0.05)。结节最大径＞1 cm[OR=2.540,95%CI(1.341,4.810),P=0.004]、微钙化[OR=2.276,95%CI(1.203,4.308),P=0.011]、双侧叶多灶[OR=3.414,95%CI(1.578,7.385),P=0.002]及突变型BRAF V600E[OR=2.663,95%CI(1.147,6.182),P=0.023]为PTC侵袭性的独立危险因素。列线图模型预测PTC侵袭性的曲线下面积为0.747[95%CI(0.679,0.815)]。结论 以基于结节最大径、微钙化、数目和分布及BRAF V600E基因检测的列线图预测PTC侵袭性具有一定价值。     

心肺转流期间老年患者局部脑氧饱和度与术后认知功能障碍的相关性

目的 探究老年患者心肺转流（CPB）期间局部脑氧饱和度（rSO₂）与术后认知功能障碍（POCD）的相关性。
方法 选择择期行CPB下心脏手术的老年患者84例,男46例,女38例,年龄≥65岁,BMI 18～29 kg/m²,ASA Ⅱ—Ⅳ级。术中应用近红外光谱技术,持续监测rSO₂。采用神经心理学测试方法评估患者术前1 d和术后第7天的认知功能,采用Z值计分法判定POCD。根据术后第7天是否发生POCD将患者分为两组：非POCD组和POCD组。CPB前期包括入室吸氧前至主动脉插管（期间包括麻醉后、手术开始、劈胸骨、悬吊心包）,CPB中期包括CPB开始至CPB结束（期间包括CPB低温恒温期及搭桥或换瓣）,CPB后期包括主动脉拔管和术毕。记录CPB前期、中期、后期rSO2平均值（rSO_2mean）,术中rSO₂最低值（rSO_2min）。采用Logistic回归和拟合曲线分析患者术中rSO₂与POCD的相关性。
结果 有36例（42.9%）患者发生POCD。多因素Logistic回归分析显示,CPB前期rSO_2mean（OR=1.12,95%CI 1.02～1.24,P=0.02）、CPB中期rSO_2mean（OR=1.55,95%CI 1.24～1.95,P<0.05）、CPB后期rSO_2mean（OR=1.32,95%CI 1.15～1.60,P<0.05）和rSO_2min（OR=1.33,95%CI 1.16～1.52,P<0.05）是发生POCD的独立危险因素。拟合曲线显示,CPB中期rSO_2mean（r=-0.60）和rSO_2min（r=-0.57）均与POCD呈线性负相关(P<0.05)。
结论 术中rSO₂降低与患者CPB术后发生POCD具有相关性。术中rSO₂降低可能是POCD的独立危险因素。     

DCE-MRI定量参数与乳腺癌生物因子的相关性

目的 探讨动态增强MRI （DCE-MRI）参数[容量转移（K_trans）、速率常数（K_ep）]与乳腺癌雌激素受（ER）、孕激素受体（PR）、人类表皮生长因子受体2（HER-2）、细胞核相关抗阳（Ki-67）的相关性。方法 回顾性分析100例经病理证实的乳腺癌患者血流动力学参数及免疫组织化学染色结果,比较不同ER、PR、HER-2、Ki-67表达强度间定量参数K_trans、K_ep值的差异及其相关性。结果 乳腺癌患者不同ER表达强度间K_trans、K_ep值差异无统计学意义（P>0.05）;且K_trans、K_ep值与ER表达强度无明显相关性（P均>0.05）。乳腺癌不同PR、HER-2、Ki-67表达强度间K_trans、K_ep差异均有统计学意义（P<0.05）,且K_trans、K_ep值与PR、Ki-67表达水平呈正相关（P<0.05）。结论 K_trans、K_ep与PR、Ki-67表达水平相关,可为诊断乳腺癌提供有价值的组织学信息。     

血管内治疗后颅内高密度/静脉窦最大密度比值预测急性缺血性脑卒中患者脑出血转化

目的 观察血管内治疗（EVT）后颅内高密度（PCHD）/静脉窦最大密度比值预测急性缺血性脑卒中（AIS）患者脑出血转化（HT）的价值。方法 回顾性分析79例EVT后即刻可见PCHD的AIS患者资料,根据有无HT将其分为HT组（n=41）及无HT组（n=38）;比较组间临床资料和CT参数,分析PCHD/静脉窦最大密度比值预测HT的价值。结果 HT组PCHD最大密度及PCHD/静脉窦最大密度比值均大于无HT组（P均＜0.001）。以87 HU为PCHD最大密度的最佳截断值,其预测AIS患者EVT后HT的敏感度、特异度及曲线下面积（AUC）分别为90.24%、71.05%及0.79;以0.94为PCHD/静脉窦最大密度比值的最佳截断值,敏感度、特异度及AUC分别为97.56%、71.05%及0.81;二者AUC差异无统计学意义（P＞0.05）。结论 EVT后即刻出现的PCHD/静脉窦最大密度比值可用于预测AIS患者HT。     

基于头颈肩最大每秒计数率及显像剂剂量预测全身骨显像扫描速度

目的 基于头颈肩最大每秒计数率(CPS_max)及显像剂用量构建全身骨显像扫描速度(SS)回归方程,并验证其价值。方法 回顾性分析385例接受全身骨显像且图像总计数(TC)≥1.50 M的患者资料,采用Person相关性分析及多重线性回归分析基于患者性别、年龄、体质量指数(BMI)、显像剂用量、扫描前等候时间,以及头颈肩CPS_max筛选全身骨显像SS的独立影响因素,构建预测全身骨显像SS回归方程。另将172例患者分为方程拟合组(n=111)和对照组(n=61),采用2台不同SPECT设备行全身骨显像,记录方程拟合组CPS_max,以回归方程设定SS,对照组以固定SS(25 cm/min)进行扫描,比较组间TC合格率(TC≥1.50 M)的差异。结果 头颈肩CPS_max和显像剂用量是全身骨显像SS的独立影响因素(P均＜0.05),以之构建的回归方程为SS=18.98+0.13×显像剂用量+1.06×CPS_max(F=23.22,P＜0.01)。方程拟合组TC合格率100%(111/111),高于对照组的88.52%(54/61,P=0.001)。结论 基于头颈肩CPS_max及显像剂用量构建的全身骨显像SS回归方程具有一定临床实用性。     

18F-FDG PET/CT动态评价单纯125I粒子植入或联合顺铂化学治疗兔VX2肺癌效果

目的 分析¹⁸F-FDG PET/CT动态观察单纯¹²⁵I粒子植入术及联合化学治疗（化疗）对兔VX2肺癌的干预效果的价值。方法 将VX2肿瘤组织接种于3~4月龄新西兰大耳白兔右肺下叶,制成兔VX2肺癌模型。将30只模型兔随机分为3组,每组10只。对A组通过治疗计划系统（TPS）植入25.9 MBq（0.7 mCi）¹²⁵I粒子,B组经耳缘静脉注射顺铂7 mg/kg体质量,C组予以上2种干预。分别于治疗前及治疗后第3、7、14天对实验兔行全身PET/CT扫描,于右肺肿瘤部位及肝右叶勾画ROI,检测其最大标准摄取值（SUV_max）,计算肿瘤SUV_max/肝脏SUV_max（SUV_T/L）;于治疗前及治疗后第3、7天完成PET/CT检查后分别处死2只,治疗后第14天PET/CT检查后处死4只动物,取肿瘤组织进行病理学检查。结果 3组间及A、B组内治疗前及治疗后不同时间点肿瘤最大径差异均无统计学意义（P均>0.05）。C组治疗后第14天肿瘤最大径较治疗前缩小（P<0.05）。治疗后第7、14天,C组SUV_T/L值较A、B组均降低（P均<0.05）;A、B组治疗后第7、14天SUV_T/L值均较治疗前降低,C组治疗后第3、7、14天SUV_T/L值均较治疗前降低（P均<0.05）。病理学检查发现3组治疗后肿瘤细胞均逐渐减少,A、C组炎症细胞及肿瘤坏死区较B组更多;C组治疗后第14天仅见少量肿瘤细胞,炎症细胞及纤维组织增多。结论 ¹⁸F-FDG PET/CT可动态监测并早期评价单纯¹²⁵I粒子植入术及联合化疗对兔VX2肺癌的干预效果。     

C7倾斜角与脊柱整体矢状面平衡的相关性

目的 探讨腰背痛患者C₇倾斜角（C₇S）与脊柱矢状面参数、脊柱矢状面平衡状态之间的关系。方法 对215例腰背痛患者进行回顾性研究,在术前、术后脊柱全长X线片上测量脊柱矢状面参数,并引入颈胸组合参数“颈椎前凸角（CL）/C₇S”。根据患者术前矢状面平衡状态（矢状面轴向距离,SVA）和胸椎代偿能力（胸椎后凸角,TK）将患者分为3类。类型A,脊柱矢状面平衡（SVA≤5 cm）;类型B,脊柱矢状面失平衡,胸椎具有代偿能力（SVA > 5 cm,TK≤40°）;类型C,脊柱矢状面失平衡,胸椎失代偿（SVA > 5 cm,TK > 40°）。分析C₇S与脊柱矢状面参数之间的相关性,比较3类患者脊柱矢状面参数的差异。结果 C₇S与T₁倾斜角（T₁S）、TK、CL、颈椎SVA（cSVA）、SVA及患者年龄之间均存在相关性（r = 0.305 ~ 0.802,P<0.05）。C₇S的变化与TK的变化有关（r = 0.494,P<0.05）,与SVA及CL的变化均无关。相比于类型A,类型B患者的SVA、CL和CL/C₇S 更大,TK更小,差异均有统计学意义（P<0.05）,cSVA、C₇S差异无统计学意义（P>0.05）;相比于类型A,类型C患者的cSVA、SVA、CL、TK、C₇S和CL/C₇S更大,差异均有统计学意义（P<0.05）;相比于类型B,类型C患者的cSVA、C₇S、CL和TK更大,差异均有统计学意义（P<0.05）,但CL/C₇S和SVA差异无统计学意义（P>0.05）。CL/C₇S评价脊柱矢状面平衡的临界值为0.618。结论 C₇S与脊柱矢状面参数之间存在较好相关性。当CL/C₇S > 0.618时,脊柱更多处于失平衡状态。     

Hybrid手术与单纯颈椎前路椎间盘切除融合术治疗颈椎退行性疾病的疗效比较

目的 对比Hybrid手术［颈椎人工椎间盘置换术（CTDR）联合颈椎前路椎间盘切除融合术（ACDF）］与单纯ACDF治疗颈椎退行性疾病的临床疗效。方法 回顾性分析2010年8月—2019年8月收治的48例双节段及三节段颈椎退行性病变患者临床资料,其中采用Hybrid手术治疗8例（Hybrid组）,采用ACDF治疗40例（ACDF组）。应用倾向性评分匹配法（PSM）对Hybrid组和ACDF组患者进行匹配,共8对匹配成功。分别采用t检验、χ²检验及重复测量方差分析比较2组患者基本资料、手术前后颈椎功能障碍指数（NDI）、日本骨科学会（JOA）评分、疼痛视觉模拟量表（VAS）评分及C_2~7活动度（ROM）的变化。结果 匹配后2组术前NDI、JOA评分、VAS评分、C_2~7 ROM差异均无统计学意义（P > 0.05）。2组手术时间、术中出血量、住院时间差异均无统计学意义（P > 0.05）。2组患者术后NDI、JOA评分、VAS评分均较术前明显改善,差异有统计学意义（P < 0.05）;且Hybrid组NDI改善优于ACDF组,差异有统计学意义（P < 0.05）。2组患者术后C_2~7 ROM均较术前下降,差异有统计学意义（P < 0.05）;C_2~7 ROM随访中逐渐增加,且Hybrid组在各随访时间点均优于ACDF组,差异有统计学意义（P < 0.05）。结论 Hybrid手术与ACDF治疗颈椎退行性疾病具有相同的临床效果,Hybrid手术在改善颈部功能和保留颈椎ROM方面优于ACDF。     

剪切波弹性成像在并存桥本甲状腺炎的甲状腺结节良恶性鉴别诊断中价值研究

目的 评价剪切波弹性成像（SWE）对桥本甲状腺炎（HT）背景下的甲状腺结节良恶性的鉴别诊断作用。方法 回顾性分析2013年1月至2014年6月中山大学附属第一医院行甲状腺手术前超声检查发现可疑结节并行SWE检查的260例病人（297个结节）的临床资料,其中合并HT者73例（83个结节）。SWE定量测量甲状腺结节时,调节感兴趣区（ROI）大小为2 mm,并置于结节内最硬处,记录ROI内SWE值（表示硬度）。结果 恶性结节的SWE值高于良性结节和周围实质,差异均有统计学意义［（64.4±42.8）kPa vs. （26.8±15.3）kPa vs. （17.7±5.3）kPa,P < 0.001］;组内恶性结节SWE值高于良性结节和周围实质（P<0.05）;组间同类结节的SWE值差异无统计学意义（P>0.05）。HT组结节周围甲状腺组织的SWE值高于非HT组（P<0.05）,且其与血清TPO-Ab之间存在正相关关系［相关系数（r）=0.307,P<0.05］。当其SWE值为39.0 kPa时,SWE技术诊断结节良恶性的敏感度、特异度及准确率分别为68.9%、91.7%和82.9%。结论 SWE值为39.0 kPa时SWE技术（ROI大小为2 mm）对于HT病人的结节良恶性具有较高的诊断价值。     

Quantitative Shear Wave Elastography as a Prognostic Implication of Papillary Thyroid Carcinoma (PTC): Elasticity Index Can Predict Extrathyroidal Extension (ETE)

Objective

To investigate whether the quantitative elasticity index of shear wave elastography (SWE) can predict extrathyroidal extension (ETE) of papillary thyroid carcinoma (PTC) preoperatively.

Methods

A total of 208 patients with pathology confirmed PTC whom underwent SWE during preoperative staging US between April 2011 to June 2012 were included.SWE indices of E _mean, E _max, E _min of the index malignancy, the ratios between E _mean of the lesion and parenchyma (E _ratio-P), and muscle (E _ratio-M), and grayscale US findings, including ETE, multifocality, bilaterality, and central and lateral lymph node (LN) metastasis were evaluated. The correlations of SWE indices and grayscale US findings with pathologic prognostic factors of PTC were analyzed by Chi square or Fisher’s exact test, and multivariate regression analysis.

Results

ETE was associated with E _mean, E _max, E _min, and E _ratio-M (P = 0.005, 0.009, 0.016 and <0.001, respectively), multifocality was associated with E _mean, E _max, and E _min (P = 0.028, 0.007, and 0.004, respectively), and central LN metastasis was associated with E _ratio-M (P = 0.03). On multivariate analysis, E _mean and E _min were independent factors for predicting ETE (P = 0.032, 0.049, respectively).

Conclusions

Quantitative elasticity index of SWE could predict pathologic ETE, and SWE could be a complimentary method to grayscale US for preoperative prediction of prognostic factors of PTC.     

甲状腺癌并存淋巴细胞性甲状腺炎的临床病理特点：附129例分析

目的:探讨甲状腺癌(TC)合并淋巴细胞性甲状腺炎(LT)的临床病理特点。方法:回顾性分析87例单纯TC(TC组)及129例TC合并LT患者临床病理资料(TC合并LT组),后者包括40例(31.0%)合并桥本氏甲状腺炎(HT),81例(62.8%)合并慢性淋巴细胞性甲状腺炎(CLT),8例(6.2%)同时合并HT与CLT。结果:所有患者均行手术治疗,根据患者病变情况分别行单侧腺叶切除、次全切除、全切除以及不同范围的淋巴结清扫术。129例TC合并LT患者中,仅1例(0.8%)为甲状腺髓样癌(MTC),其余(99.2%)均为甲状腺乳头状癌(PTC)。与TC组比较,TC合并LT组女性、微小癌、单叶受累、颈淋巴结阴性比率均明显增加,而病灶最大径明显减小(均P0.05);在TC合并LT组中,并CLT患者与合并HT患者各项临床病理指标均无统计学差异(均P0.05)。结论:与LT并存的TC以PTC多见,且多为女性,LT可能对TC原发灶生长及腺内、颈部淋巴结转移有抑制作用;TC合并CLT与合并HT的临床病理特征相似。     

IgG4阳性桥本甲状腺炎超声表现

目的探讨IgG4阳性桥本甲状腺炎的超声表现。方法回顾性分析72例经我院手术病理证实为桥本甲状腺炎患者的临床和超声资料。根据免疫组化染色结果分为IgG4阳性组19例、IgG4阴性组53例。比较2组甲状腺的回声类型、合并结节情况、血流分布及甲状腺功能状态。结果 2组间甲状腺内低回声比例、网格样线样高回声比例、合并甲状腺癌比例差异均有统计学意义(P均0.05),2组间伴发结节数量、甲状腺血流分布、甲状腺功能状态差异均无统计学意义(P均0.05)。结论超声可为临床诊断IgG4阳性桥本甲状腺炎提供有价值的影像学依据。     

Young's Modulus of Bilateral Infraspinatus Tendon Measured in Different Postures by Shear Wave Elastography Before and After Exercise

ObjectiveTo investigate the Young''s modulus value of infraspinatus tendons using shear wave elastography (SWE) technique in normal adults, and to analyze the influence of gender, postures, exercise, and dominant side on Young''s modulus of infraspinatus tendons.MethodsThis is a prospective cross‐sectional study. From January 2019 to July 2020, 14 healthy subjects were identified, including seven males and seven females aged between 24 to 34, with a mean age of 27.67 ± 3.08 years. The Young''s modulus of their infraspinatus tendons was measured by two operators using SWE in neutral and maximum external rotation positions of both sides before exercise and the dominant side after exercise. The Young''s modulus values in different sexes, different postures, before vs after exercise, and dominant vs non‐dominant side were statistically analyzed.ResultsAll 14 subjects completed the data collection process. The mean Young''s modulus values of infraspinatus tendon for dominant sides in neutral position were 33.04 ± 3.01 kPa for males and 28.76 ± 3.09 kPa for females. And for non‐dominant sides in the neutral position, the values were 33.02 ± 2.38 kPa for males and 28.86 ± 2.47 kPa for females. In the maximum external rotation position, the values for dominant sides were 50.19 ± 4.86 kPa for males and 42.79 ± 4.44 kPa for females, and for non‐dominant sides were 50.95 ± 3.24 kPa for males and 42.42 ± 3.66 kPa for females. After exercise, the mean Young''s modulus values of infraspinatus tendon for dominant sides in neutral position were 54.56 ± 3.76 kPa for males and 46.66 ± 5.99 kPa for females. And for the maximum external rotation position, the values were 59.13 ± 3.78 kPa for males and 54.49 ± 5.67 kPa for females. The Young''s modulus of infraspinatus tendon in the neutral and maximum external rotation positions showed statistically significant differences in males and females, as well as before and after exercise (P < 0.05). However, the difference in Young''s modulus between the dominant and non‐dominant sides was not statistically significant (P > 0.05). Intergroup reliability between both operators was excellent (ICC > 0.85).ConclusionThere are gender‐related differences and post‐exercise increase in Young''s modulus, yet such a difference cannot be witnessed between the dominant and non‐dominant sides.     

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??Diagnosis in thyroid nodules with coexistent chronic autoimmune Hashimoto thyroiditis by shear wave elastography LIANG Jin-yu*??LIU Bao-xian??WANG Wei??et al. *Department of Medical Ultrasonics??Institute of Diagnostic and Interventional Ultrasound??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080,China
Corresponding author: WANG Wei??E-mail??wangw73@mail.sysu.edu.cn
Abstract Objective To assess the diagnostic performance of shear wave elastography (SWE) in the differentiation of thyroid nodules with coexistent Hashimoto thyroiditis??HT??. Methods From January 2013 to June 2014??conventional ultrasound (US) and SWE were performed on 297 suspicious thyroid nodules of 260 patients with histological confirmation. 73 patients with 83 nodules were included in the HT group. Results SWE value in the maglignant nodule was significant higher than that in the benign one and surrounding parenchyma (64.4±42.8??kPa vs??26.8±15.3??kPa vs??17.7±5.3??kPa, P<0.05). SWE value in HT group of malignant module was significantly higher than that of benign one and surrounding parenchyma. In the benign and malignant nodules??SWE value between HT and non-HT groups showed no significant differences (P>0.05). SWE value of surrounding parenchyma in HT group was higher than that in non-HT group and had positive correlation with TPO-Ab(r=0.307, P<0.05). Optimal value of SWE to diagnose malignancy was 39.1kPa with sensitivity, specificity and accuracy 68.9%,91.7% and 82.9%, respectively. Conclusions 39.0 kPa of SWE value showed good diagnostic performance in the differentiation of malignant and benign thyroid nodules with coexistent HT.     

甲状腺乳头状癌合并桥本甲状腺炎的临床病理研究

目的:探讨桥本甲状腺炎(HT)与甲状腺乳头状癌(PTC)之间的关系。方法:回顾性分析2010年1月—2015年5月495例接受手术治疗,术后病理诊断为PTC的患者资料,比较伴有和不伴有HT患者的临床病理特点。结果:495例PTC患者中,伴发HT者108例(21.81%)。单因素分析结果显示,与单纯PTC患者比较,PTC并HT患者中女性多见(90.7% vs.71.6%)、术前促甲状腺激素(TSH)水平(4.04 μIU/mL vs.2.76 μIU/mL)及甲状腺过氧化物酶抗体(TPOAb)水平偏高(94.31 IU/mL vs.33.65 IU/mL)、肿瘤最大径偏小(1.10 cm vs.1.31 cm)、临床分期偏早(I期87.1% vs.76.8%),差异均有统计学意义(均P0.05)。Logistic回归分析显示,患者的性别、TSH水平、TPOAb水平、临床分期是PTC合并HT的独立预测因素(均P0.05)。结论:PTC合并HT患者中,女性较多,临床分期较早,并且肿瘤偏小,提示合并HT并未增加PTC的侵袭性,预后较好。但合并HT的患者TSH水平偏高,提示HT可能是PTC的发病风险因素之一。     

Tireoidite de Hashimoto pode estar associada a um subgrupo de pacientes de esclerose sistêmica com hipertensão pulmonar

IntroductionRecent studies show an association between autoimmune thyroiditis and systemic sclerosis (SSc) and suggest that this condition may interfere with the ES phenotype. However these studies evaluate the autoimmune thyroiditis as a whole and none of them specifically addresses Hashimoto's thyroiditis (HT) in SSc.ObjectiveTo investigate the presence of HT in SSc patients and its possible association with disease manifestations.MethodsClinical manifestations of hypothyroidism, TSH and anti‐thyroid auto antibodies (anti‐TPO. anti TBG and TRAb) were studied in 56 patients with SSc. SSc patients with HT were compared with SSc patients without thyroiditis.ResultsHT was observed in 19.64% of patients with SSc. No association was observed between HT and the different forms of disease or profile of autoantibodies. Likewise, there was no difference between the mean modified Rodnan score and presence of Raynaud's phenomenon, scars, digital necrosis, myositis, arthritis, sicca symptoms, esophageal dysmotility and scleroderma renal crisis when the groups were compared. On the other hand, patients with HT had higher frequency of pulmonary hypertension in relation to patients without HT (66.6% vs 22.5%, p = 0.016).ConclusionsIn the studied sample patients with ES and HT had higher prevalence of pulmonary hypertension. Long‐term follow‐up studies with a larger number of TH and SSc patients are needed to confirm these data.     

Coexistence of papillary thyroid cancer with Hashimoto thyroiditis

Aims

Conflicting data have been reported with regard to Hashimoto thyroiditis (HT) and risk of malignancy. The aim of this study was to evaluate coexistence of papillary thyroid cancer (PTC) with HT.

Patients and methods

This is a retrospective cohort study in which HT was diagnosed in 452 (F/M ratio?=?405:47, median age 53.5?±?12.1 years) of 7,545 patients qualified for thyroidectomy throughout the years 2002 to 2010. Pathological reports were reviewed to identify prevalence of PTC in HT vs. non-HT patients.

Results

PTC was diagnosed in 106 of 452 (23.5 %) HT patients vs. 530 of 7,093 (7.5 %) non-HT patients (p?<?0.001). Metastases to level VI lymph nodes were observed in 81 of 106 (76.4 %) patients with PTC in HT vs. 121 of 530 (22.8 %) patients with PTC in non-HT disease (p?<?0.001).

Conclusions

HT was associated with a threefold increase of PTC prevalence as compared to other non-HT thyroid diseases, and the spread of PTC to level VI lymph nodes was four times more frequent in HT than in non-HT patients.     

甲状腺乳头状癌患者侧颈区淋巴结转移影响因素分析

背景与目的：甲状腺乳头状癌（PTC）是甲状腺癌中占比最大的病理类型,PTC的侧颈区淋巴结转移（LLNM）是导致患者复发和再手术的主要原因。因此,本研究分析PTC患者的临床特征,探讨发生LLNM的影响因素,并构建临床预测模型,为制定合理的手术范围提供参考依据。方法：回顾性分析锦州医科大学附属第一医院2018年3月—2022年1月行手术治疗的PTC患者临床资料,比较发生LLNM与未发生LLNM患者临床病理因素的差异,将有统计学意义的因素纳入多因素Logistic回归分析,用R 4.1.3建立PTC患者LLNM风险预测列线图模型,并绘制校准曲线评价该模型的精准度,用ROC曲线界定LLNM独立危险因素的诊断截断值。结果：共纳入597例PTC患者,其中,187例（31.32%）发生LLNM。单因素分析显示,年龄、肿瘤直径、多发癌灶、腺外侵犯、颈中央区淋巴结转移（CLNM）与BRAFV600E基因突变为PTC患者发生LLNM的影响因素（均P<0.05）。年龄、肿瘤直径、发生腺外侵犯、存在CLNM和BRAFV600E基因突变是LLNM的独立危险因素（均P<0.05）。基于以上影响因素构建...