术前fT4/fT3比值与甲状腺功能检查在甲状腺结节良恶性鉴别诊断中的临床研究  

Value of preoperative detection of fT4/fT3 ratio and thyroid function test in differentiation of benign and malignant thyroid nodules

作　　者：赵跃[1,2] 王宁 刘春蓉 张桐硕[4] 黄景昊[1] 孙甲甲 周广磊[1] 王英楠[1] 吴凤云[1] ZHAO Yue;WANG Ning;LIU Chun-rong;ZHANG Tong-shuo;HUANG Jing-hao;SUN Jia-jia;ZHOU Guang-lei;WANG Ying-nan;WU Feng-yun(Department of Thyroid and Breast Surgery,Logistics University of PAP,Tianjin 300309,China;Logistics University of PAP,Tianjin 300309,China)

机构地区：[1]武警后勤学院附属医院甲状腺和乳腺外科 [2]武警后勤学院,天津300309 [3]武警后勤学院附属医院病理科 [4]武警后勤学院附属医院检验科,天津300162

出　　处：《海南医学院学报》2018年第20期1833-1837,共5页Journal of Hainan Medical University

基　　金：国家自然科学基金项目(81302577)~~

摘　　要：目的:分析甲状腺结节患者的临床及病理学特点,探讨甲状腺恶性结节的相关危险因素。方法:根据纳入及排除标准,选择在我院就诊的甲状腺结节283例。根据术后组织病理结果将其分为两组,良性组(良性结节)172例,恶性组(恶性结节)111例。单因素分析两组患者的年龄、性别、血清甲状腺球蛋白抗体(TgAb)、过氧化物酶抗体(TPOAb)、促甲状腺素(TSH)、游离甲状腺素(fT4)、游离三碘甲状腺原氨酸(fT3)水平、fT4/fT3的比值等结果,再用多因素Logistic回归分析筛选甲状腺恶性结节的危险因素。结果:单因素分析结果显示,年龄、TgAb、fT4(P<0.05)和fT4/fT3的比值(P<0.01)在两组间有显著的统计学差异。fT4/fT3的比值是恶性结节的危险因素(OR:2.065,95%CI:1.270-3.357);多因素logistic回归分析结果显示,年龄(OR:0.934,95%CI:0.911-0.957),TgAb(OR:2.069,95%CI:1.008-4.247)、fT4(OR:1.206,95%CI:1.038-1.401)水平是恶性结节的危险因素。结论:术前血清fT4/fT3的比值对鉴别甲状腺结节良恶性具有重要诊断价值,当fT4/fT3>3时增加了恶性结节的风险。患者年龄及血清学指标TgAb、fT4水平是甲状腺恶性结节的独立危险因素,可指导甲状腺良恶性结节的鉴别诊断。Objective： To analyze the clinical and pathological characteristics of thyroid nodules in ooder to explore the related risk factors of malignant thyroid nodules. Methods： A total of 283 eligible patients with thyroid nodules that were treated in our hospital during January 2015 and December 2017 enrolled and divided into benign group （benign thyroid nodule group, n =172） and malignant group （malignant thyroid nodule, n =111） based on postoperative histopathological results. The age, sex, serum thyroglobulin antibody （TgAb）, thyroid peroxidase antibody （TPOAb）, thyroid stimulating hormone （TSH）, free thyroxine （fT4）, free three iodine thyroxine （fT3） and fT4/ fT3 ratio were subjected to univariate analysis, and the risk factors of malignant thyroid nodule were screened by multivariate logistic regression analysis. Results： Univariate analysis showed that age, TgAb, fT4 （ P 〈0.05） and fT4/ fT3（ P 〈0.01） were significantly different between the two groups. The fT4/fT3 ratio was a risk factor of malignant nodules（ OR： 2.065,95% CI ： 1.270-3.357）. Multivariate logistic regression analysis indicated that the risk factors of malignant thyroid nodule were age （ OR： 0.934,95% CI ：0.911-0.957）, TgAb（ OR： 2.069,95% CI ： 1.008-4.247）and fT4 （ OR： 1.206,95% CI ： 1.038-1.401）. Conclusion： The fT4/fT3 ratio has important diagnostic value in differentiation of benign and malignant thyroid nodules. A fT4/fT3 ratio that is higher than 3 may indicate high risk of malignancy. The age, TgAb and fT4 are independent risk factors for malignant thyroid nodule, which is of great value in differentiation of benign and malignant thyroid nodules.

关 键 词：甲状腺结节 良性 恶性 危险因素 LOGISTIC回归分析 

分 类 号：R581[医药卫生—内分泌] R736.1[医药卫生—内科学]