甲状腺结节患者临床特征研究

目的　分析甲状腺结节患者的临床资料，为甲状腺结节良恶性的鉴别提供依据。方法　收集2014年1月—2015年2月于昆明医科大学第一附属医院因甲状腺结节行手术切除的646例患者的临床资料，以术后病理检查结果为诊断标准，比较不同基本资料、病史、血脂异常情况、超声影像特点、CT影像特点的甲状腺结节患者恶性结节发生率，检测甲状腺良、恶性结节患者促甲状腺激素（TSH）、甲状腺球蛋白抗体（TGAb）滴度、甲状腺过氧化物酶抗体（TPOAb）滴度。分析术前超声、CT对甲状腺结节性质的鉴别诊断价值及甲状腺结节恶性的危险因素。结果　不同年龄段甲状腺结节患者恶性结节发生率比较，差异有统计学意义（P<0.05）；不同BMI、饮食碘摄入情况、甲状腺癌家族史情况、其他恶性肿瘤家族史情况甲状腺结节患者恶性结节发生率比较，差异有统计学意义（P<0.05）。本研究患者均行甲状腺超声检查，不同性质、低回声情况、边界、形态、结节内血流情况、纵横比、边缘成角情况、内部钙化情况、颈部淋巴结肿大情况的甲状腺结节患者恶性结节发生率比较，差异有统计学意义（P<0.05）。共85例患者行CT增强扫描，不同边界、颈部淋巴结肿大情况甲状腺结节患者恶性结节发生率比较，差异有统计学意义（P<0.05）。本研究患者均行TSH检测，恶性结节患者TSH高于良性结节患者（P=0.006）。行甲状腺自身抗体滴度检测的患者共395例，恶性结节患者TGAb滴度及TPOAb滴度均较良性结节患者高（P<0.001）。与术后病理检查结果比较，术前超声鉴别甲状腺结节性质的灵敏度为97.60%、特异度为82.77%、诊断符合率为89.47%，术前CT鉴别甲状腺结节性质的灵敏度、特异度、诊断符合率依次为95.12%、68.18%、81.18%。多因素Logistic回归分析显示，年龄较小、肥胖、饮食碘摄入多，超声检查甲状腺结节形态不规则、结节内血流丰富、纵横比≥1、边缘成角、内部有钙化，TSH升高及TPOAb滴度升高是甲状腺结节恶性的危险因素（P<0.05）。伴、不伴颈部淋巴结转移的甲状腺恶性结节患者结节内血流、内部有钙化情况比较，差异有统计学意义（P<0.05）。结论　年龄较小（30~49岁）、肥胖、饮食碘摄入多，超声检查甲状腺结节形态不规则、结节内血流丰富、纵横比≥1、边缘成角、内部有钙化，TSH升高及TPOAb滴度升高是甲状腺结节恶性的危险因素；甲状腺结节内血流丰富及内部钙化更多见于伴颈部淋巴结转移的甲状腺癌。

Study on Clinical Characteristics of Thyroid Nodules

Objective　To analyze the clinical data of patients with thyroid nodules，so as to provide evidence for differentiating benign and malignant nodules.Methods　The clinical data of 646 patients undergoing surgical resection of thyroid nodules at the First Affiliated Hospital of Kunming Medical University from January 2014 to February 2015 were collected.The incidence of malignant nodules were compared in different basic clinical data，medical history，dysipidemia ultrasound features and CT features patients with thyroid nodules.　Thyroid stimulating hormone（TSH），anti-thyroglobulin antibodies（TGAb） and anti-thyroid peroxidase antibodies（TPOAb） levels were compared between the patients with benign and malignant thyroid nodules.The diagnostic value of ultrasonography and CT for thyroid nodules and the influencing factors of malignant thyroid nodules were analyzed.Results　The proportion of malignant nodules varied significantly in age groups（P<0.05），the incidence of malignant nodules were significantly different in patients with different BMI，dietary iodine intake，family history of thyroid cancer，and family history of other malignancies（P<0.05）.All patients received ultrasonography，and the incidence of malignant nodules were significantly different in patients with different properties，hypoechoic conditions，boundaries，shape，blood flow in nodules，longitudinal and transverse diameter ratio，edge angle，calcification and enlargement of cervical lymph nodes（P<0.05）.There were 85 cases undergoing enhanced CT scanning，and the incidence of malignant nodules were significantly different in patients with different boundarie rders and enlargement of cervical lymph nodes（P<0.05）.All patients were given test of serum TSH levels，and a higher TSH level was detected in patients with malignant nodules than that in patients with benign nodules（P=0.006）.A total of 395 patients were given measurement of antithyroid autoantibodies，and the TPOAb titer and TGAb titer were higher in patients with malignant nodules than those patients with benign nodules（P<0.001）.Compared with the postoperative pathology，preoperative ultrasound showed a 97.60% sensitivity，82.77% specificity，and 89.47% diagnostic coincidence rate for differentiating benign and malignant thyroid nodules，and CT scan exhibited a 95.12% sensitivity，68.18% specificity，and 81.18% diagnostic coincidence rate for differentiating benign and malignant thyroid nodules.Multivariate Logistic regression analysis revealed that the development of malignant thyroid nodules was associated with young age，obesity，high dietary iodine intake，irregular nodule morphology as revealed by ultrasound，abundant blood flow in nodules，longitudinal and transverse diameter ratio of 1 and greater，edge angle，calcification and elevated TSH and TPOAb titier levels（P<0.05）.In addition，there were significant differences in abundant blood flow in nodules and calcification between the patients with malignant thyroid nodules in the presence and absence of cervical lymph node metastasis（P<0.05）.Conclusion　Young age（30 to 49 years），obesity，high dietary iodine intake，irregular nodule morphology as revealed by ultrasound，abundant blood flow in nodules，longitudinal and transverse diameter ratio of 1 and greater，edge angle，calcification and elevated TSH and TPOAb titer levels are risk factors of malignant thyroid nodules.Notably，abundant blood flow in nodules and calcification are more likely to occur in thyroid cancer with cervical lymph node metastasis.