甲状腺结节术前检查对其良恶性诊断的预测价值

目的 探讨预测甲状腺结节（TN）良恶性的术前检查指标。 方法 收集济宁市第一人民医院2016年2月至2019年2月接受甲状腺手术的513例TN患者的临床资料，其中男性111例、女性402例，年龄13~80（49.02±12.95）岁。以患者术后病理结果为“金标准”，分为良性组（275例）和恶性组（238例）。检测患者的血清促甲状腺激素（TSH）、甲状腺球蛋白（Tg）、甲状腺球蛋白抗体（TgAb）和甲状腺过氧化物酶抗体（TPOAb）的水平。患者行甲状腺超声和甲状腺静态显像检查，采用超声甲状腺影像报告和数据系统进行分级。采用t检验、卡方检验及Mann-Whitney秩和检验比较2组患者的基本资料；采用单因素回归、Logistic多因素回归对所有指标进行分析，并预测甲状腺癌的相关危险因素。 结果 2组TN患者的年龄（χ2=26.716，P=0.000）、体重指数（t=−2.301，P=0.022）、结节功能状态（χ2=16.882，P=0.001）、结节直径大小（χ2=151.817，P=0.000）、TSH水平（Z=−4.430，P=0.000）和超声检查（χ2=225.712，P=0.000）均存在差异，且差异有统计学意义；2组患者的性别、肿瘤家族史、文化程度、合并症、体重、身高、Tg、TgAb和TPOAb水平的差异均无统计学意义。单因素分析结果显示，TN患者的年龄、体重、文化程度、TSH和Tg水平、结节直径大小、超声检查（OR=1.004、0.980、0.514、1.280、1.002、1.222、0.589，均P< 0.05）可能与甲状腺癌相关。Logistic多因素回归分析结果显示，TSH水平（OR=1.198，P=0.046）、年龄（OR=0.962，P=0.001）和结节直径大小（OR=0.251，P=0.000）是甲状腺癌的独立危险因素，超声检查（OR=16.390，P=0.000）预测意义较大。 结论 超声检查对预测甲状腺癌有重要意义，结合患者年龄、血清TSH水平和结节直径大小，预测甲状腺癌的价值可能更大。

Predictive value of preoperative examination of malignancy of thyroid nodules

Objective To explore the risk factors that can predict the pathological diagnosis of thyroid cancer before operation. Methods A total of 513 patients underwent surgery and received pathological diagnosis from February 2016 to February 2019 in the Jining First People′s Hospital were identified. Of these patients, 111 were males and 402 were females. Their ages ranged from 13 years old to 80 years old. The age was 49.02±12.95 years old. The patients were classified into benign and malignant groups (275 and 238 cases, respectively) according to their postoperative pathology. The biochemical parameters of thyroid stimulating hormone (TSH), thyroglobulin (Tg), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were evaluated. Thyroid ultrasound and thyroid static imaging were performed, and thyroid imaging-reporting and data system were used for grading. The basic data of the two groups were compared by using Student's t test, chi-square test, and a Mann–Whitney rank sum test. The univariate regression analysis and logistic multivariate regression analysis were conducted to examine the risk of malignant thyroid nodules. Results Differences in age (χ2=26.716, P=0.000), body mass index (t=−2.301, P=0.022), nodule function (χ2=16.882, P=0.001), nodule size (χ2=151.817, P=0.000), TSH (Z=−4.430, P=0.000), and ultrasound (χ2=225.712, P=0.000) between benign and malignant groups were observed. No significant differences were found in gender, family history of cancer, educational level, complication, weight, height, Tg, TgAb, and TPOAb. The univariate regression analysis revealed that age, weight, educational level, TSH, Tg, nodule size, and ultrasound (OR=1.004, 0.980, 0.514, 1.280, 1.002, 1.222, 0.589, all P<0.05) may be associated with malignancy. Logistic multivariate regression analysis revealed that the increase in TSH level (OR=1.198, P=0.046), young patient (OR=0.962, P=0.001) and small nodule diameter (OR=0.251, P=0.000) were independently associated with higher malignant of thyroid nodule, and ultrasound (OR=16.390, P=0.000) was significant in the prediction of pathological diagnosis. Conclusions Ultrasound plays an important role in predicting thyroid cancer. The combination of ultrasound and other factors, such as patient age, serum TSH level, and nodular diameter, can predict the pathological diagnosis accurately.