体检人群甲状腺结节的检出情况及相关因素分析

目的了解体检人群甲状腺结节(TN)的检出情况及相关因素,探讨甲状腺彩超检查的重点人群及是否应将其列为常规体检项目。方法选择2010年1-12月在河北省人民医院体检中心进行甲状腺超声检查的13664例体检者作为研究对象,并进行血脂、血糖、血压等检测。其中8596例体检者同时进行甲状腺外科触诊检查。甲状腺超声检测发现TN的236例体检者进行甲状腺功能检查。结果体检人群TN检出率为47.43%。外科触诊检出TN的体检者经甲状腺超声均检出TN。随着结节直径的增大,外科检出率逐渐升高,直径1cm以上的TN外科检出率>50%。TN如不伴甲状腺增大对血清中总三碘甲状腺原胺酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原胺酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平无影响。甲状腺超声检查异常的各组抗甲状腺过氧化物酶抗体(TPO)均高于正常组,差异有统计学意义(P<0.05)。与未检出TN的体检者比较,检出TN的体检者收缩压、空腹血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇均升高,差异有统计学意义(P<0.01)。结论 TN在体检人群中的检出率不低,但多数为良性结节,对甲状腺功能无明显影响,重点人群和有条件的地方应推荐做甲状腺超声检查。

Detection of Thyroid Nodule in Health Check-up People and Analysis of its Related Influential Factors

Objective To understand the detection rate of thyroid nodules（TN） in people taking health check-up and its related influential factors. Methods 13 664 subjects who took thyroid ultrasound examination during January to December of 2010 in the medical examination center of Hebei Provincial People＇ s Hospital were selected, and at the same time, their blood lipids, blood glucose, blood pressure and other items were tested. Among them, 8 596 subjects also took surgical thyroid palpation examination. And for 236 cases with positive TN by thyroid ultrasound examination, thyroid function tests were conducted further. Results The positive rate of TN in the physical examination population was 47.43%. The cases who detected positive TN by surgical thyroid palpation were also detected positive by thyroid ultrasound. As the nodule diameter increasing, the surgery detection rate was gradually increased; the detection rate for cases with TN diameter more than 1 cm was above 50%. If TN without thyroid enlargement, the levels of serum total triiodothyronine （Tr3）, total thyroxine（T Y4）, free triiodothyronine （171＂3）, free thyroxine （ FT4 ） and thyroid-stimulating hormone （TSH） were not affected. The levels of thyroid peroxidase （ TPO ） antibody were higher in groups with abnormal results of thyroid ultrasound examination than in the normal group, the differences were statistically significant （P〈0.05）. Compared with subjects without detected TN, the levels of systolic blood pressure, fasting plasma glucose, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol were elevated in subjects with detected TN （P〈0.01）. Conclusion The detection rate of TN in physical examination crowd is not low, but the majority is of benign nodules and no significant effect on thyroid function. It is recommended for people in high risk or in condition permitted to take thyroid uhrasonography.