江苏社区人群甲状腺结节的流行病学研究

采用逐级分层整群抽样抽取江苏地区城乡6层样本,调查对象为20岁以上的常住(≥5年)居民6 128人进行甲状腺超声检查及甲状腺功能检测,应用7.5 MHz/50 mm探头B超诊断仪进行甲状腺超声检查,记录甲状腺结节部位、直径、数量、回声、边界、钙化等.采用固相化学发光酶免疫分析法(ICMA法)检测促甲状腺素(TSH),对于TSH在正常范围外的人群,检测游离三碘甲状腺原氨酸(FT3)和游离甲状腺激素(FT4).调查对象甲状腺结节的粗患病率为21.12%、标化患病率为15.69%;男性和女性的粗患病率为14.55%和25.24%,标化患病率为11.20%和20.40%(P＜0.05).以单发结节和直径＜1.0 cm的结节为主,不同年龄段甲状腺结节直径＜1.0 cm和≥1.0 cm构成比之间的差异无统计学意义(P＞0.05),而不同年龄段单发结节和多发结节构成比之间的差异有统计学意义(P＜0.05).江苏地区社区人群的甲状腺结节的患病率较高,加强对其随访和早期诊治有重要意义.

Abstract：

The residents who had lived for at least 5 years and aged over 20 years old were sampled from urban to rural districts of Jiangsu Province with a stratified cluster sampling technique. B mode ultrasonography and thyroid function determination were carried out in 6 128 persons. The location, diameter, number, boundary, and calcification in thyroid nodules were described by using 7.5 MHz/50 mm transducer of thyroid ultrasonography. TSH was measured by chemiluminescence immunoassay. Free triiodothyronine(FT3)and free thyroxin(FT4)were measured when TSH was abnormal. The crude prevalence of thyroid nodules was 21.12% in total population, 14.55% in male, and 25.24% in female. The standardized prevalence was 15.69%, 11.20%, and 20.40%, respectively. The prevalence was lower in male than in female, and increased with age(P＜0.05). Thyroid nodules in Jiangsu Province were highly prevalent and more attention should be paid to the follow-up, early diagnosis, and treatment.     

无锡地区鸡弓形虫感染的血清流行病学调查

目的了解无锡地区散养鸡的弓形虫感染状况。方法应用ELISA方法调查无锡地区309例散养鸡的弓形虫抗原、抗体阳性率,并与150例集约化养殖鸡的弓形虫感染率进行比较,其中一项阳性即视为弓形虫感染阳性。结果 309例散养鸡中,抗原阳性29例,阳性率为9.39%;抗体阳性53例,阳性率为17.15%;双阳性13例,双阳性率为4.21%;散养鸡总体阳性率为22.33%。集约化养殖鸡总体弓形虫感染率为2.67%。散养鸡感染率显著高于集约化养殖鸡感染率(χ2=29.19,P<0.01)。结论无锡地区散养鸡群弓形虫感染率较高,应引起重视。     

南京市40岁以上人群甲状腺结节的流行病学调查

本课题组对南京市栖霞区9 947名40 ～79岁常住居民进行了甲状腺结节患病率的调查,采用超声检查记录甲状腺回声类型,结节部位、数量、大小、回声及钙化类型.结果显示甲状腺结节患病率为26.7％,其中男性20.2％,女性30.0％,女性的患病率在各年龄组均显著高于男性(P＜0.01).甲状腺结节患病率在不同性别组内均呈随年龄增加而升高的趋势.单个甲状腺结节的患病率最高,达到65.0％,长径小于1 cm的结节所占比例最大,为61.5％.甲状腺结节最常见的回声类型为低回声,各种回声类型在不同性别患者中分布无差异.甲状腺结节总体钙化率为11.2％,甲状腺结节的钙化率在不同性别和年龄中分布差异无统计学意义.     

中老年人群甲状腺结节发病状况调查

目的了解中老年人群甲状腺结节的发病情况。方法对938例既往无甲状腺疾病史的离退休职工进行高分辨率甲状腺B超检查。结果本组资料甲状腺结节检出率男女分别为37．16％和45．70％，其中女性结节的发生率随年龄增长而显著升高（P〈0．05）；〈1．0cm的微小结节占多数，男女分别为67．81％及64．08％；随着年龄的增长多发结节的比例上升，男性〉70岁的多发结节占57．14％，显著高于〈70岁人群（P〈0．05）。结论我国中老年人群甲状腺结节的发病率高，应重视甲状腺结节的早期诊断和早期治疗。     

宁夏人群旋毛虫病血清流行病学调查

本文报告了用快速薄膜ELISA人试验对宁夏城乡人群7810人份旋毛虫血清进行流行病学调查的结果。阳性率1.7％(132/7810)。男、女性的阳性率分别为1.8％(63/3551)和1.6％(69/4259),两者间无显著性差异(x~2=0.4169,P>0.05)。人群各职业阳性率间也无显著差异(x~2=9.7851,P>0.05)。各年龄组阳性率间有显著性差异(x~2=30.424,P<0.05)。汉族阳性率1.9％(109/5782)高于回族阳性率1.1％(23/2 011),且有显著性差异(x~2=4.9261,P<0.05)。     

重庆市永川地区人群甲状腺结节与尿碘关系

目的 探索重庆市永川地区人群甲状腺结节患病情况与尿碘的关系,为制定防控方案提供依据.方法 结合人群健康体检,选择过去半年未使用含碘制剂及近10日内未食用海水产品者作为检查对象;采用B超检查甲状腺;采集尿液检测尿碘;用x2 检验计数资料显著性,以P＜0.05为差异有统计学意义.结果 共检查775人,年龄为18～80岁,平...     

高碘地区儿童甲状腺结节的调查分析

目的了解高碘地区学龄儿童甲状腺结节的检出率,为高碘甲状腺肿的防治工作提供科学依据。方法对山东省巨野县6~13岁儿童226名和山西省平遥县6~15岁256名儿童进行甲状腺B超检查和尿碘检测。结果本次调查共发现患有甲状腺结节的儿童为6例,检出率1.2%,尿碘中位数为437.7μg/L。尿碘<100μg/L组学龄儿童的甲状腺结节检出率较高,为6.3%;100~199μg/L组学龄儿童甲状腺结节检出率为2.6%;200~299μg/L组的检出率最低,为0.0%;≥300μg/L组的检出率为1.3%,不同尿碘水平甲状腺结节检出率无统计学意义,χ2=3.387,P>0.05。不同年龄甲状腺结节检出率无差异,χ2=0.194,P>0.05。儿童的性别之间甲状腺结节检出率无差异,χ2=0.604,P>0.05。不同年龄组尿碘中位数无明显差异(H=0.281,P>0.05)。不同性别儿童尿碘中位数无明显差异(Z=-0.467,P>0.05)。检出有结节组与无结节组学龄儿童的尿碘中位数分别为324.2μg/L和440.9μg/L,两者之间无统计学意义(Z=-1.688,P>0.05)。结论高碘地区存在儿童甲状腺结节,儿童甲状腺结节的成因有待进一步研究。     

体检人群脂肪肝与甲状腺结节的相关性

目的探讨脂肪肝与甲状腺结节之间的相关性。方法于某三甲医院体检科参加健康体检的衡水市职工21 916例,行腹部超声、甲状腺超声检查及肝肾功能、血糖、血脂检测。结果 1甲状腺结节患病率31.70%、脂肪肝患病率29.03%、两病共患的患病率为9.54%。2脂肪肝组甲状腺结节患病率(32.86%)明显低于非脂肪肝组(31.23%)(P=0.018)。3甲状腺结节男性患病率(26.94%)明显低于女性(37.72%)(P=0.000);脂肪肝男性患病率(36.84%)明显高于女性(17.83%)(P=0.000);两病共患中男性患病率(5.70%)明显高于女性(3.84%)(P=0.000)。4甲状腺结节患病率随年龄增长逐渐升高,60岁患病率最高,达到48.84%;脂肪肝及两病共患随年龄增长患病率也在逐渐升高,但60岁反而较50~60岁年龄组下降(P=0.000)。5不同职业人群中,专业技术人员甲状腺结节患病率最高(33.73%),国家机关人员次之(33.47%),脂肪肝、两病共患患病率均为国家机关人员最高,分别为35.29%、11.93%(P=0.000)。6多因素Logistic回归分析显示:性别(OR=2.075,95%CI:1.947~2.210)、年龄(OR=1.540,95%CI:1.496~1.585)、脂肪肝(OR=1.171,95%CI:1.092~1.256)可能是患甲状腺结节的独立危险因素。结论衡水市职工脂肪肝个体甲状腺结节的患病率增高,脂肪肝可能是甲状腺结节患病的独立危险因素。     

黔南民族地区农村老年人高血压流行病学调查

<正>60岁以上老年人群高血压患病率为49.1%,占我国老年疾病的首位,是老年人致死、致残的主要原因〔1〕。现有研究多以非民族地区老年人为调查对象〔2⁹〕,本研究探讨贵州省黔南布依族苗族自治州高血压的患病情况及影响因素。1对象与方法1.1研究对象整群抽取黔南州2县(三都水族自治县、平塘县)中3个民族乡(镇)8个村60岁以上沟通无障碍的732名少数民族老年人,其中小学及以下文化程度729人,均为农民;     

宁夏人群囊虫病血清流行病学调查

本文报告1989年7—11月用快薄膜ELISA试验对宁夏人群7810人份囊虫病血清流行病学调查的结果。全区41个调查点共调查7810人,阳性217人,阳性率为2.8％。其中汉族5782人,阳性184人,阳性率3.2％,回族2011人,阳性32人,阳性率1.6％。经统计学处理,回、汉阳性率间有显著性差异(x~2=14,P<0.005)。男、女性别阳性率间无显著性差异。不同职业阳性率间有差异。不同年龄组感染阳性率间有显著性差异,并有随年龄增大而阳性率上升的趋势。     

江苏地区老年人主观性耳鸣的流行病学调查

目的 探讨老年人耳鸣的分布情况，为制订防治策略提供科学依据。方法 采用按容量比例概率抽样方法，在江苏省常住人口中抽样，对1149名60岁及以上的老年人进行耳鸣问卷调查，并做出评估。结果 被调查人群的耳鸣患病率为29．6％（标化患病率：全国29．7％，江苏29．8％）。耳鸣患病率随年龄增加逐渐上升，但年龄组间差异无统计学意义（P〉O．05），性别之间差异亦无统计学意义（男29．9％，女29．3％，P〉0．05），农村人群耳鸣患病率（31．8％）高于城镇（25．1％）（P〈O．05）。有意义的耳鸣患病率为2．5％，年龄、性别及城乡之间差异均无统计学意义（P〉O．05）。结论 耳鸣在老年人群中较为常见。耳鸣与多种因素有关，有必要加强老年人耳鸣的防治研究。     

The associated factors for spontaneous intranodular hemorrhage of partially cystic thyroid nodules: A retrospective study of 101 thyroid nodules

Spontaneous intranodular hemorrhaging in benign partially cystic thyroid nodules was reported to cause neck swelling, difficulty swallowing, and other oppressive symptoms attributed to their growing progressively at high rates. In our study, the risk factors for hemorrhaging in these nodules were investigated.We retrospectively analyzed benign partial cystic thyroid nodules from September 2017 to December 2019, and divided them into 2 groups according to the occurrence of intranodular hemorrhage. Age, gender, follow-up time nodules initial maximum diameter, blood supply, spongiform content, nodules solid components, and internal solid portion were compared between the 2 groups at the first ultrasound examination. Chi-Squared and multivariate analysis were performed to evaluate the association of hemorrhage with clinical and ultrasonographic characteristics. ROC analysis was performed to evaluate the utility of factors in predicting hemorrhage.There were 59 occurrences of intranodular hemorrhage, which were associated with abundant blood supply, spongiform contents, and unsmooth margin of the internal solid portion. After multivariate analysis, abundant blood supply, and spongiform content were independent predictors for hemorrhage. In ROC analysis integrating these predictors, the sensitivity was 62.7% and specificity was 95.2% with the AUC 0.881.Partially cystic thyroid nodules with abundant blood supply, non-smooth margin of the internal solid portion and a spongiform internal content were apt to spontaneous intranodular hemorrhaging, which can be recognized as soon as possible by ultrasound.     

Molecular pathogenesis of thyroid nodules and cancer

Tumours derived from the thyroid follicular epithelium represent an informative model for understanding the molecular pathogenesis of multistage tumourigenesis, which is the prevailing theory on cancer development and progression nowadays. The early stages of thyroid tumour development appear to be the consequence of the activation or 'de novo' expression of several proto-oncogenes or growth factor receptors, such as ras, ret, NTRK, met, gsp and the thyrotropin (TSH) receptor. Alterations in the expression pattern of these genes are associated with the development of differentiated neoplasms, ranging from benign toxic adenomas (gsp and TSH receptor), to follicular (ras) and papillary (ret/PTC, NTRK, met) carcinomas. They may all be considered to be early events of thyroid cell transformation and, for some, experimental evidence derived from gene transfer studies supports this hypothesis. Alterations in tumour suppressor genes (p53, Rb) are associated instead with the most aggressive and poorly differentiated forms of thyroid cancer, indicating that, in the thyroid tumourigenic process, they represent late genetic events. Specific environmental factors (iodine deficiency, ionizing radiations) have been shown to play a crucial role in promoting the development of thyroid cancer, influencing both its genotypic and phenotypic features. Interestingly, a high percentage of genetic lesions causing thyroid cancer originate from gene rearrangements and chromosomal translocations (ret/PTC, NTRK, Pax-8/PPARgamma) a finding which, being a rare event in most epithelial tumours, makes the molecular pathogenesis of thyroid cancer unique. The uninterrupted flow of information on the molecular genetics of thyroid nodules and cancer will broaden the correlation between genotype and phenotype and will also provide important information for the development of more accurate preoperative diagnostic tools and more efficient treatment choices for the different forms of thyroid cancer.     

Interobserver variability in ultrasound assessment of thyroid nodules

The first diagnostic tool for thyroid disease management is ultrasound. Despite its importance, ultrasound is an extremely subjective procedure that requires a high level of performance skill. Few studies have assessed thyroid ultrasound performance and its effectiveness, particularly the variability between observers in the assessment of ultrasound images. This study evaluated the variability in ultrasound assessments and diagnoses of thyroid nodules between 2 radiologists. In this retrospective study, 75 thyroid nodules in 39 patients were reviewed by 2 experienced radiologists. The nodule composition, margin, shape, calcification, and vasculitis were determined using echogenicity. The study evaluation included these 5 assessments and the final diagnosis. Interobserver variation was determined using Cohen kappa statistics. The interobserver agreements in the interpretation of echogenicity, shape, and margin were fair (κ = 0.21–0.40), whereas there were substantial agreements for vascularity and calcification (κ = 0.62–0.78). The agreements between the observers for individual ultrasound features in this study were the highest for vascularity and the presence/absence of calcification. The interobserver reproducibility for thyroid nodule ultrasound reporting was adequate, but the diagnostic evaluation ability of the observers was inconsistent. The variability in the interpretation of sonographic features could influence the level of suspicion of thyroid malignancy. This study emphasizes the need for consistency in the training of sonographic interpretation of thyroid nodules, particularly for echogenicity, shape, and margin.     

探讨甲状腺小结节的径线特征及其对结节定性诊断的价值

目的探讨甲状腺小结节(结节长径≤10 mm)的径线特征及其与结节良、恶性的关系,提高高频超声对甲状腺小结节定性诊断的准确性。方法对病理诊断的353例患者的665个甲状腺小结节(结节长径≤10 mm)的前后径与横径进行分析比较,观察超声声像图特征。结果恶性结节对于前后径≥横径的敏感性及特异性都很高(93.6%、97.4%),良、恶性结节相比有显著差异性(P<0.05);不规则边界、不完整晕环、微钙化、穿入血流,恶性结节的敏感性及阳性预测值都很低;恶性结节对于低回声的敏感性高(89.2%),特异性低(19.1%)。结论根据小结节的径线特征利于甲状腺微小癌的早期诊断。     

山东省巨野县成人甲状腺结节的典型调查研究

目的研究不同碘氟摄入量人群甲状腺结节和TPOAb阳性的检出率。方法对山东巨野县的适碘低氟、高碘低氟和高碘高氟3个农村地区共396名23岁以上居民进行甲状腺B超检查、TPOAb和尿碘测定。结果适碘低氟组、高碘低氟组和高碘高氟组尿碘中位数（MUI）分别为207.1、383.9和461.7μg/L;甲状腺结节检出率16.5%、22.0%和11.5%,TPOAb阳性率25.9%、33.7%和12.4%。高碘高氟组人群甲状腺结节检出率明显低于高碘低氟组人群（P〈0.05）。各组人群随着年龄的增大,甲状腺结节检出率增高,60岁以上最高,分别为24.4%、29.2%和18.8%,经趋势性卡方检验有显著意义（P〈0.05）。高碘高氟组甲状腺B超正常人群TPOAb阳性率明显低于适碘低氟组和高碘低氟组。结论在水碘200~300μg/L范围内,若水氟自（0.99±0.29）mg/L升至（1.67±0.19）mg/L,无论是甲状腺结节检出率还是TPOAb阳性率均明显降低。