甲状腺结节中医证型与超声特征的关系研究  

Study on the Correlation Between Traditional Chinese Medicine Syndrome Types and Ultrasonic Features of Thyroid Nodules

作　　者：张娇娇 陈务民[2] ZHANG Jiao-Jiao;CHEN Wu-Min(The Eighth Clinical Medical School of Guangzhou University of Chinese Medicine,Foshan 528000 Guangdong,China;Foshan Hospital of Traditional Chinese Medicine,Foshan 528000 Guangdong,China)

机构地区：[1]广州中医药大学第八临床医学院,广东佛山528000 [2]佛山市中医院,广东佛山528000

出　　处：《广州中医药大学学报》2023年第12期2972-2978,共7页Journal of Guangzhou University of Traditional Chinese Medicine

摘　　要：【目的】探讨甲状腺结节患者的中医证型与超声特征之间的关系。【方法】采用前瞻性研究方法,收集2022年1月至2022年12月在广州中医药大学第八临床医学院(即佛山市中医院)门诊和住院部接受治疗的甲状腺结节患者共234例,记录患者的超声特征包括结节数量、结节成分、结节边缘、有无钙化、结节内回声均匀情况、结节回声类型、结节分级及血流分级情况等;同时,根据中医辨证分型标准对患者进行辨证分型,分析不同中医证型甲状腺结节患者超声特征的差异。【结果】(1)中医证型分布方面,234例患者中,以痰结血瘀型患者最多,达76例(32.48%),其他根据分布频次从高到低依次为肝火旺盛型59例(25.21%)、气郁痰阻型41例(17.52%)、心肝阴虚型41例(17.52%)、脾肾阳虚型17例(7.26%)。(2)中医证型与超声特征之间的关系方面,研究结果显示:不同中医证型患者的结节数量(单发或多发)、血流分级(0级、Ⅰ级、Ⅱ级、Ⅲ级)比较,差异均无统计学意义(P>0.05);而不同中医证型患者的结节回声类型(无回声、等回声、较低回声、混合回声、低回声、极低回声)、结节形态(纵横比>1或纵横比<1)、结节内回声均匀情况(均匀或不均匀)、结节成分(囊性、囊实性、液实性、实性)、结节边缘(清晰或欠清晰)、有无钙化(有钙化或无钙化)比较,差异均有统计学意义(P<0.05或P<0.01)。组间两两比较发现,气郁痰阻型患者的甲状腺结节以实性结节、结节边缘欠清晰、伴钙化及纵横比>1占比明显较肝火旺盛型高,且其美国放射学会(ACR)的甲状腺影像报告和数据系统(TI-RADS)分类评分在5种证型患者中相对更高,以TR5级为主(占43.90%);而肝火旺盛型患者的结节超声表现以混合回声、回声均匀、纵横比<1、边缘清晰、无钙化为主,ACR TI-RADS分类评分以TR3级(52.54%)及以下多见。其余证型组间比较,差异均无统计学意义(PObjective To investigate the correlation between traditional Chinese medicine(TCM)syndromes and ultrasonic features in patients with thyroid nodules.Methods A prospective study was conducted in 234 outpatients and inpatients with thyroid nodules from the Eighth Clinical Medical School of Guangzhou University of Chinese Medicine(also known as Foshan Hospital of Traditional Chinese Medicine)from January 2022 to December 2022.The ultrasonic findings of the patients in terms of the number of nodules,composition of the nodules,margins of the nodules,presence or absence of calcification,homogenous echoes in the nodules,echo types of nodules,grading of the nodules,and grading of blood flow were recorded.Moreover,syndrome differentiation was carried out in the patients according to the TCM syndrome classification criteria,and the differences in the ultrasonic features of patients with thyroid nodules of various syndrome types were analyzed.Results(1)The distribution of TCM syndrome types revealed that,the phlegm-accumulation and blood stasis type accounted for the most among the 234 patients(76 cases,32.48%),and then came hyperactive liver-fire type(59 cases,25.21%),qi depression and phlegm obstruction type(41 cases,17.52%),heart-liver yin deficiency type(41 cases,17.52%),and spleen-kidney yang deficiency type(17 cases,7.26%).(2)The analysis of relationship between TCM syndromes and ultrasonic findings showed that there was no statistically significant difference in the number of nodules(single or multiple)and blood flow grading(grade 0,gradeⅠ,gradeⅡ,and gradeⅢ)among patients with different TCM syndrome types(P>0.05),but statistically significant differences were presented in the echo types of nodules(anechoic,isoechoic,hypoechoic,mixed-echoic,hypoechoic,very hypoechoic),nodular morphology(aspect ratio>1 or aspect ratio<1),homogenous echoes in the nodules(homogenous or inhomogeneous),properties of the nodules(cystic,cystic solid,liquid solid,solid),margins of the nodules(clear or unclear),and presence or absence of

关 键 词：甲状腺结节 超声特征 中医证型 气郁痰阻型 肝火旺盛型 

分 类 号：R259.813[医药卫生—中西医结合]