老年甲状腺结节的发病特点

目的 了解老年人甲状腺结节的检出情况及发病特点.方法 对2013年4月-2014年5月在河北联合大学附属唐山工人医院体检中心进行健康检查的698例老年人甲状腺超声结果进行分析,并对各年龄组结节的发病率、大小、数目及性质进行比较.结果 ①老年人甲状腺结节发病率为70.9％,随年龄增长甲状腺结节发病率逐渐增加(x2＝11.97,P＜0.01),其中女性结节发病率(77.3％)明显高于男性(64.0％),差异有统计学意义(x2=15.080,P＜0.01).②检出甲状腺结节的老年人群中,小结节所占比例达72.3％,大结节占27.7％,随年龄增长,大结节所占比例逐渐增加(x2=4.840,P＜0.05).不同性别间甲状腺大小构成比比较,差异无统计学意义(x2=0.092,P＞0.05).③检出甲状腺结节老年人群中,单发结节占26.7％,多发结节占73.3％,且多发结节比例随年龄增长逐渐增加(x2=9.297,P＜0.01).不同性别间甲状腺数量构成比比较,差异无统计学意义(x2=1.869,P＞0.05).④根据甲状腺高分辨彩超声显示的结节内部回声特点,实性结节所占比例为79.8％,囊实性结节占18.4％,囊性结节占1.8％.结节性质在不同年龄组和不同性别之间比较,差异均无统计学意义(均P＞0.05).结论 老年人甲状腺结节发病率较高,应重视甲状腺结节的早期诊治.     

Evaluating the validity of model for end‐stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm

Liver transplant allocation policy does not give model for end‐stage liver disease (MELD) exception points for patients with a single hepatocellular carcinoma (HCC) <2 cm in size, but does give points to patients with multiple small nodules. Because standard‐of‐care imaging for HCC struggles to differentiate HCC from other nodules, it is possible that a subset of patients receiving liver transplant for multiple nodules <2 cm in size does not have HCC. We evaluate risk of post‐transplant HCC recurrence and wait‐list dropout for patients with multiple small nodules using competing risks regression based on the Fine and Gray model. We identified 5002 adult HCC patients in the OPTN/UNOS dataset diagnosed and transplanted between January 2006 and September 2010. Compared to patients with >1 tumor <2 cm, risk of developing recurrence was significantly higher in patients with one or more tumors with only one tumor ≥2 cm (SHR 1.63, p = 0.009), as well as in patients with 2–3 tumors ≥2 cm (SHR 1.84, p = 0.02). Dropout risk was not significantly different among size categories. HCC recurrence risk was significantly lower in patients with multiple nodules <2 cm in size than in those with larger tumors, supporting the possibility that some patients received unnecessary transplants. The priority given to these patients must be re‐examined.     

高频超声诊断甲状腺结节的多因素分析及病例对照研究

目的采用高频超声对甲状腺结节的多因素进行诊断分析,并对其病例进行对照研究,为甲状腺结节的准确诊断提供可靠的方法。方法通过整体随机抽样的方法,对某地区的居民进行问卷调查、甲状腺的高频超声和尿碘值的检测;将高频超声检测结果甲状腺结节为阳性的和甲状腺没有病变的群体按照年龄、性别、职业和城乡的区别配比,分为两组,每组400例,对两个组别进行病例对照研究;对研究结果进行单因素和多因素的Logistic回归分析相关的危险因素。结果结合单因素和多因素分析,结果显示甲状腺结节的保护因素和患者的年收入相关,年收入越高的患甲状腺结节的概率越低,有吸烟史的患甲状腺结节的概率越高,检测分析甲状腺结节患病率低的尿碘值一般在100~190μg/L(P0.05)。结论通过高频超声对甲状腺结节的患者进行单一因素和多因素对比分析,结果发现饮食习惯和使用的碘量和甲状腺结节的发生率有一定的相关性,尿碘值的高低也影响着甲状腺结节的发生率。高频超声在诊断甲状腺结节方面起着一定的作用,可以作为临床诊断甲状腺结节推广使用。     

Ultrasound-guided fine-needle aspiration of thyroid nodules: does the size limit its efficiency?

Purpose: The management criterion of thyroid nodules is to evaluate the risk of malignancy, based on cytological examinations. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) has a highly diagnostic value for thyroid nodules. The aim of this study was to compare the efficacy of US-FNAB for thyroid nodules with different sizes. Material and methods: From August 2013 to November 2013, 344patients with thyroid nodules who had undergone US-FNAB were divided into three groups, according to the largest diameter of their nodules (group A, ≤ 5.0 mm; group B, 5.1-10.0 mm; group C, > 10.0 mm). All the nodules were subsequently verified by histology or follow-up findings. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value of aspiration cytology in each group was compared. Results: Among 344 thyroid nodules diagnosed by cytology, the cytology was classified as nondiagnostic or unsatisfactory for 53 (15.4%) lesions, benign for 144 (41.9%) lesions, atypia of undetermined significance or follicular lesion of undetermined significance for 20 (5.8%) lesions, follicular neoplasm or suspicious for a follicular neoplasm for 26 (7.6%) lesions, suspicious for malignancy for 36 (10.5%) lesions, malignant for 65 (18.9%) lesions. There were 243 benign and 101 malignant nodules confirmed by the pathological or follow-up ultrasound. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were confirmed to be 87.5% (14/16), 92.5% (37/40), 91% (51/56), 82.3% (14/17), and 94.8% (37/39) in group A; 92.3% (36/39), 96.9% (94/97), 95.5% (130/136), 92.3% (36/39), and 96.9% (94/97) in group B; and 91.3% (42/46), 93.4% (99/106), 92.7% (141/152) 85.7% (42/49), and 96.1% (99/103), in group C. There were no statistical differences in accuracy, sensitivity, specificity, false positive accuracy, false negative rate of fine needle aspiration of thyroid nodules with different sizes (P > 0.05). Conclusion: US-FNAB has similar diagnostic efficacy to thyroid nodules with different sizes.     

射频消融治疗甲状腺实性结节642例疗效观察

目的：探讨射频消融(RFA)治疗甲状腺实性结节的疗效及安全性。方法选取2011年1月至2013年1月我院采用超声引导下射频消融治疗甲状腺实性结节患者64例,随访观察术后肿块体积、结节缩小率、甲功指标等。结果 RFA治疗前患者结节平均大小为(2.52±1.79) cm3,随访6个月后患者的结节平均大小为(0.31±1.02) cm3,治疗前后甲状腺结节变化差异有统计学意义(P<0.05);结节缩小率(VRR)平均为(94.52±11.39)%,其中有21例结节完全消失(VRR=100%),治愈率为32.81%;35例VRR>50%,有效率为54.69%;8例VRR在25%~50%范围内,好转率为12.50%;治疗后1个月检测患者甲功指标,促甲状腺激素(TSH）、血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)水平均在正常值范围内,与术前比较差异均无统计学意义(P>0.05);治疗前检测患者血清抗甲状腺球蛋白抗体(TG-Ab)和抗甲状腺过氧化物酶抗体(TPO-Ab)分别为(30.54±16.32) IU/ml和(67.52±22.43) IU/ml,术后患者分别为(26.73±17.95) IU/ml和(63.08±27.74) IU/ml,差异均无统计学意义(P>0.05);6例患者术中感到颈部疼痛,但均能忍受,停止消融后疼痛即可缓解,有2例患者穿刺部位皮肤红肿,经抗炎治疗后痊愈;未发现皮肤烧伤、血肿、食管穿孔、气管损伤、声音嘶哑、饮水呛咳、神经损伤等并发症。结论射频消融治疗甲状腺实性结节安全和有效,并发症少,无手术疤痕,美容效果好,值得临床推广。     

甲状腺单发良恶性结节的CT表现

目的:探讨甲状腺单发良恶性结节的CT表现特征及其鉴别点。方法:收集甲状腺单发结节122例,对其发病年龄、性别及CT表现进行统计学分析。结果:甲状腺良恶性结节的大小、囊变、边界差别没有统计学意义,甲状腺良恶性结节的形态、节段性缺损、钙化、实性部分强化及颈部淋巴结增大差别有统计学意义。结论:CT增强扫描在甲状腺良恶性结节的鉴别诊断中发挥重要作用。     

上海市浦东新区全科医生甲状腺结节及分化型甲状腺癌相关知识了解情况调查

背景　目前我国甲状腺结节的患病率为20%~76%,已成为内分泌系统的第二大疾病。早发现、早诊断、早治疗是防治甲状腺肿瘤的有效措施,全科医生在其中发挥着重大作用。但是,社区卫生服务中心对甲状腺疾病的管理还存在许多不足之处。目的　了解上海市浦东新区全科医生对甲状腺结节及分化型甲状腺癌（DTC）相关知识的了解情况,发现不足之处并提出改进方法,以期推进甲状腺疾病分级诊疗。方法　于2017-12-20至2018-01-10,依据上海市浦东新区的城乡划分,即城镇地区、城郊结合地区、郊区,使用计算机在各区随机整群抽取3家社区卫生服务中心的全部全科医生为调查对象,采用问卷星形式进行调查,调查内容包括一般资料、甲状腺结节的良恶性评估、甲状腺结节术前及术后管理、DTC术后促甲状腺激素（TSH）抑制治疗和管理及全科医生甲状腺疾病管理能力自我评估。结果　本研究共发放问卷309份,回收307份,有效回收率为99.4%。在全科医生对甲状腺结节良恶性的评估方法的了解情况评估中,对电子计算机断层扫描、磁共振成像及2-氟-2-脱氧D-葡萄糖正电子发射断层显像术,TSH,甲状腺球蛋白的了解程度,不同职称和学历全科医生之间比较,差异均有统计学意义（P<0.05）;不同职称全科医生对血清降钙素的了解程度比较,差异有统计学意义（P<0.05）。在全科医生对甲状腺结节术前及术后管理的了解情况评估中,不同职称全科医生对甲状腺结节术前随访时间、细针穿刺抽吸活检适应证和术后TSH抑制治疗、左甲状腺素替代治疗的了解程度比较,差异均有统计学意义（P<0.05）;不同学历全科医生对甲状腺结节术前随访时间、131I治疗的适应证和禁忌证的了解程度比较,差异均有统计学意义（P<0.05）。在全科医生对DTC术后TSH抑制治疗和管理的了解情况评估中,不同职称全科医生对术后首选L-T4口服制剂、L-T4服用方法、L-T4剂量调整、TSH水平监测的了解程度比较,差异均有统计学意义（P<0.05）;不同学历全科医生对L-T4剂量调整、心脏监测的了解程度比较,差异均有统计学意义（P<0.05）。全科医生对甲状腺结节良恶性评估方法的了解情况得分为（19.1±6.9）分、对甲状腺结节术前与术后管理的了解情况得分为（14.0±7.2）分和对DTC术后TSH抑制治疗和管理的了解情况得分为（13.7±8.4）分,不同学历、职称全科医生对这3部分相关知识的了解情况得分以及总分比较,差异均有统计学意义（P<0.05）;且不同职称、学历全科医生对甲状腺疾病管理能力自我评估比较,差异均有统计学意义（P<0.05）。结论　上海市浦东新区全科医生对甲状腺结节及DTC相关知识的了解较为欠缺,尤其是对甲状腺结节患者的术前转诊随访及术后治疗管理、DTC患者术后TSH抑制治疗和管理的了解,且自我评估对甲状腺疾病的管理能力缺乏信心,需要加强学习和临床培训。