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超声检查在甲状腺大结节成年患者中的应用价值

李艳辉 赵晨希 陈明 杨爽灵 薛现军

李艳辉, 赵晨希, 陈明, 杨爽灵, 薛现军. 超声检查在甲状腺大结节成年患者中的应用价值[J]. 中华全科医学, 2022, 20(10): 1742-1745. doi: 10.16766/j.cnki.issn.1674-4152.002693
引用本文: 李艳辉, 赵晨希, 陈明, 杨爽灵, 薛现军. 超声检查在甲状腺大结节成年患者中的应用价值[J]. 中华全科医学, 2022, 20(10): 1742-1745. doi: 10.16766/j.cnki.issn.1674-4152.002693
LI Yan-hui, ZHAO Chen-xi, CHEN Ming, YANG Shuang-ling, XUE Xian-jun. Application value of ultrasound in adult patients with thyroid nodules ≥3 cm[J]. Chinese Journal of General Practice, 2022, 20(10): 1742-1745. doi: 10.16766/j.cnki.issn.1674-4152.002693
Citation: LI Yan-hui, ZHAO Chen-xi, CHEN Ming, YANG Shuang-ling, XUE Xian-jun. Application value of ultrasound in adult patients with thyroid nodules ≥3 cm[J]. Chinese Journal of General Practice, 2022, 20(10): 1742-1745. doi: 10.16766/j.cnki.issn.1674-4152.002693

超声检查在甲状腺大结节成年患者中的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.002693
基金项目: 

河南省医学科技攻关计划联合共建项目 LHGJ20191377

详细信息
    通讯作者:

    李艳辉,E-mail:huihuiliyanhui@126.com

  • 中图分类号: R581R445.1

Application value of ultrasound in adult patients with thyroid nodules ≥3 cm

  • 摘要:   目的  明确≥3.0 cm甲状腺结节(TNS)和<3.0 cm TNS的超声(US)影像差异,探讨超声在≥3.0 cm甲状腺结节患者中的应用价值。  方法  选择2017年3月—2019年8月在平煤神马医疗集团总医院、新乡医学院三全学院、濮阳市油田总医院进行US检查并行甲状腺手术切除的患者545例。根据甲状腺结节最大直径将患者分为大结节组(115例,152个结节)和小结节组(352例,417个结节)。大结节组为甲状腺结节≥3.0 cm的患者;小结节组为甲状腺结节<3.0 cm的患者。对比分析甲状腺大结节与小结节患者的临床与US影像特点。  结果  (1) 大结节组患者的微钙化率(28.94%)、低回声率(40.13%)、形态不规则率(13.82%)均高于小结节组患者(18.94%、7.19%、3.36%,均P < 0.05);大结节组患者的囊性结构率(9.21%)、混合性结节率(30.26%)、高回声率(30.92%)、结节周围血管率(4.61%)均低于小结节组患者(18.94%、48.44%、42.93%、13.43%,均P < 0.05)。(2)甲状腺大结节与小结节的TI-RADS分级诊断结果比较,差异无统计学意义(P>0.05)。(3)US检查对甲状腺大结节诊断的正确率为74.3%(113/152)。大结节是甲状腺结节恶性的危险因素(OR=2.674, 95% CI: 1.116~6.405, P=0.027)。  结论  ≥3.0 cm的TNS患者US特征和<3.0 cm的TNS患者US特征存在差异。与甲状腺小结节相比较,甲状腺大结节具有更高的恶变风险。

     

  • 图  1  甲状腺大结节典型患者的US影像

    注:A为甲状腺左侧叶良性结节的US二维声像图;B为甲状腺左侧叶良性结节的彩色多普勒声像图;C为甲状腺右侧叶乳头状癌US二维声像图;D为甲状腺右侧叶乳头状癌彩色多普勒声像图。

    Figure  1.  US image of a typical patient with a large thyroid nodule

    表  1  2组TNS患者的社会人口学资料比较

    Table  1.   Comparison of sociodemographic data between two groups of patients with TNS

    组别 例数 年龄(x±s,岁) 性别[例(%)] 农村户籍[例(%)] BMI (x±s) 吸烟[例(%)] 饮酒[例(%)] 脑卒中史[例(%)] 冠心病[例(%)] 高血压[例(%)] 高血脂[例(%)] 糖尿病[例(%)]
    男性 女性
    大结节组 115 47.42±7.93 46(40.00) 69(60.00) 47(40.87) 27.82±4.51 34(29.57) 67(58.26) 2(1.74) 12(10.43) 30(26.09) 23(20.00) 17(14.78)
    小结节组 352 48.02±8.05 147(41.76) 205(58.24) 149(42.33) 28.09±4.84 112(31.82) 201(57.10) 3(0.85) 34(9.66) 101(28.69) 75(21.31) 49(13.92)
    统计量 0.696a 0.111b 0.076b 0.528a 0.205b 0.048b 0.079b 0.059b 0.292b 0.089b 0.053b
    P 0.486 0.739 0.783 0.598 0.651 0.827 0.779 0.809 0.589 0.765 0.818
      注:at值,bχ2值。
    下载: 导出CSV

    表  2  2组TNS患者的US影像特点比较[例(%)]

    Table  2.   Comparison of US imaging characteristics between two groups of patients with TNS [cases(%)]

    组别 例数 结节单发 固体纹理 微钙化 低回声 形态不规则 结节形态直立性生长 囊性结构 混合性结节
    大结节组 152 93(61.18) 70(46.05) 44(28.94) 61(40.13) 21(13.82) 3(1.97) 14(9.21) 46(30.26)
    小结节组 417 268(64.27) 209(50.12) 79(18.94) 93(7.19) 14(3.36) 4(9.59) 79(18.94) 202(48.44)
    χ2 0.457 0.081 11.178 27.798 25.508 0.293 7.720 14.970
    P 0.499 0.777 0.001 < 0.001 < 0.001 0.588 0.005 < 0.001
    组别 例数 高回声 强回声 结节内血管 结节周围血管 粗钙化 彗星尾征 海绵状外观
    大结节组 152 47(30.92) 8(5.26) 23(15.13) 7(4.61) 17(11.18) 6(3.95) 8(5.26)
    小结节组 417 179(42.93) 23(5.52) 64(15.35) 56(13.43) 38(9.12) 18(4.32) 22(5.28)
    χ2 6.705 0.014 0.004 8.809 0.547 0.038 < 0.001
    P 0.010 0.907 0.949 0.003 0.459 0.846 0.995
    下载: 导出CSV

    表  3  2组TNS患者的TI-RADS分级诊断结果比较[例(%)]

    Table  3.   Comparison of TI-RADS classification between two groups of patients with TNS [cases(%)]

    组别 例数 TI-RADS 1级 TI-RADS 2级 TI-RADS 3级 TI-RADS 4级 TI-RADS 5级 TI-RADS 6级
    大结节组 152 0 9(5.92) 58(38.16) 47(30.92) 34(22.37) 4(2.63)
    小结节组 417 0 22(5.28) 169(40.53) 131(31.41) 92(22.06) 3(7.19)
      注:2组分级诊断结果比较,U=0.495,P=0.620。
    下载: 导出CSV

    表  4  TNS恶性影响因素的logistic回归分析

    Table  4.   Logisitic regression analysis of influencing factors of TNS malignancy

    变量 B SE Wald χ2 P OR 95% CI
    大结节 0.984 0.446 4.871 0.027 2.674 1.116~6.405
    微钙化 0.815 0.206 15.629 < 0.001 2.259 1.508~3.384
    结节含有固体成分 1.341 0.376 12.699 < 0.001 3.821 1.828~7.987
    低回声 0.940 0.380 6.140 0.013 2.561 1.217~5.388
    形态不规则 1.774 0.444 15.922 < 0.001 5.892 2.466~14.080
      注:赋值方法如下,大结节(1=是,0=否);微钙化(1=是,0=否);结节含有固体成分(1=是,0=否);低回声(1=是,0=否);形态不规则(1=是,0=否)。
    下载: 导出CSV

    表  5  US对甲状腺大结节的诊断效果(例)

    Table  5.   Diagnostic effect of US on greater thyroid nodules (cases)

    病理检查 US检查 合计
    + -
    + 33 2 35
    - 37 80 117
    合计 70 82 152
    下载: 导出CSV
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  • 收稿日期:  2021-09-21
  • 网络出版日期:  2022-11-30

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