健康体检人群甲状腺结节患病率及其与代谢性疾病的关系研究

背景　甲状腺结节发病隐匿，多数患者早期无症状，早期识别高危人群并开展早期干预，对于甲状腺疾病的防治至关重要，而高分辨率超声是早期发现甲状腺结节的有效手段。既往有研究结果显示，甲状腺结节与代谢性疾病存在明显相关性，但研究结果尚不一致。目的　了解健康体检人群的甲状腺结节患病率，分析甲状腺结节与代谢性疾病的关系。方法　选取2018年1月—2019年1月陆军军医大学第一附属医院健康管理中心的受检者2 309例，根据高分辨率甲状腺超声检查结果进行甲状腺结节的诊断。纳入分析的代谢性疾病包括超重/肥胖、中心性肥胖、糖调节受损/糖尿病、高血压、血脂异常、代谢综合征、高尿酸血症、脂肪肝，采用多因素Logistic回归分析代谢性疾病与甲状腺结节的关系。结果　受检者的甲状腺结节患病率为37.38%（863/2 309），女性高于男性〔44.91%（362/806）比33.33%（501/1 503），P<0.01〕，甲状腺结节患病率随年龄增加呈升高趋势（P<0.01）。多因素Logistic回归分析结果显示，控制了性别、年龄因素后，脂肪肝是健康体检人群患甲状腺结节的保护因素（P<0.05）；无论是在男性健康体检者中还是在女性健康体检者中，控制了年龄因素后，代谢性疾病对其是否患甲状腺结节无影响（P<0.05）。结论　西南地区健康体检人群的甲状腺结节患病率较高，女性和高龄人群是甲状腺结节患病的高危人群，应进一步加强筛查和管理。脂肪肝是甲状腺结节患病的保护因素，未发现其他代谢性疾病对甲状腺结节患病的影响。

Prevalence of Thyroid Nodules in Health Checkups and Its Relationship with Metabolic Diseases

Background The incidence of thyroid nodules is insidious,and most patients are asymptomatic in the early stage.With the popularization of high-resolution ultrasound,the early identification and intervention of high-risk population of thyroid nodules is feasible,which is crucial for the prevention and treatment of thyroid diseases.Objective To investigate the prevalence of thyroid nodules in health checkups and analyze its relationship with metabolic diseases.Methods The 2309 subjects who participated in the health checkups in the Health Management Center of the First Hospital Affiliated to Army Medical University from January in 2018 to January in 2019 were included in the study.High-resolution thyroid ultrasonography was used to identify the thyroid nodules.The metabolic diseases included in the analysis were overweight/obesity,central obesity,impaired glucose regulation/diabetes,hypertension,dyslipidemia,metabolic syndrome,hyperuricemia,and fatty liver.The multivariate Logistic regression was used to analyze the relationship between metabolic diseases and incidence of thyroid nodules.Results The prevalence of thyroid nodules was 37.38%(863/2309),and females had significantly higher prevalence of thyroid nodules than males〔44.91%(362/806)vs 33.33%(501/1503),P<0.01〕.The prevalence of thyroid nodules increased with age(P<0.01).Multivariable Logistic regression showed that after controlling for gender and age,fatty liver was a protective factor for thyroid nodules(P<0.05);after controlling for age,metabolic diseases had no effect on the incidence of thyroid nodules both in females and males(P<0.05).Conclusion The prevalence of thyroid nodules is relatively higher in the southwestern region of China,and females and older people are holding the high risk for developing thyroid nodules.The screening and management should be further strengthened in females and elderly population.Fatty liver is a protective factor for the disease of thyroid nodules.No other metabolic diseases have been found to affect the disease of thyroid nodules.