TI-RADS 4类甲状腺结节患者的超声弹性应变率比值与结节性质的关联  

Relationship between ultrasonic elastic strain rate ratio and nodule properties in patients with TI-RADS4 thyroid nodules

作　　者：柯和平 宋晓艳 KE Heping;SONG Xiaoyan(Department of Ultrasound,Hanyang Hospital,Wuhan University of Science and Technology,Wuhan,Hubei,430051,China)

机构地区：[1]武汉科技大学附属汉阳医院超声科,湖北武汉430051

出　　处：《中国耳鼻咽喉头颈外科》2024年第3期141-146,151,共7页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨甲状腺影像报告和数据系统(TI-RADS)4类甲状腺结节患者的超声弹性应变率比值(strain ratio,SR)与结节性质的关联。方法选择2018年1月~2023年2月于武汉科技大学附属汉阳医院接受治疗的95例甲状腺结节患者(结节数共128枚)为研究对象,根据病理学检查结果分为良性组(n=50)和恶性组(n=45),比较两组患者的一般资料。利用最小绝对收缩选择算子(least absolute shrinkage and selection operator,LASSO)回归法和多因素Logistic回归分析影响患者结节性质的危险因素。按SR从低到高等分为五分位数组(Q1~Q5),比较5组患者的临床资料特征,并采用多因素Logistic回归分析SR与恶性结节风险的相关性,建立限制性立方样条Logistic回归模型分析其剂量-反应关系。采用限制性三次样条回归法分析SR与甲状腺恶性结节中央区淋巴结转移风险的非线性关联。建立回归方程y=1-1/(1+e-z)预测模型并进行验证。结果良性组与恶性组患者在舒张末期血流速度(end diastolic velocity,EDV)、促甲状腺激素(TSH)、收缩期峰值血流速度(peak systolic velocity,PSV)、阻力指数(resistance index,RI)、SR之间的差异均有统计学意义(P<0.05);LASSO回归和多因素Logistic回归分析显示调整潜在混杂因素后,发现TSH、PSV、RI增大、EDV及SR降低均为影响患者结节性质的独立危险因素(P<0.05);SR与恶性结节风险存在独立相关性(OR=0.60,95%CI 0.41~0.81,P<0.001),且SR从低到高五分位数组趋势性检验差异有统计学意义(P趋势<0.001);限制性立方样条模型分析显示,男性或女性的SR与恶性结节风险均不存在非线性关系。限制性三次样条回归分析显示,SR和甲状腺恶性结节中央区淋巴结转移风险存在显著相关性。SR=-2.1时,线性P<0.0001。经Bootstrap自抽样,预测模型区分度、准确度较好。结论TI-RADS4类甲状腺结节患者的SR和结节性质具有独立相关性,SR能够通过病灶组织的硬度判�OBJECTIVE To investigate the relationship between the ultrasonic elastic strain rate ratio(SR)and the nodule properties of thyroid nodules in patients with thyroid imaging reporting and data system(TI-RADS).METHODS Ninety-five patients with thyroid nodules(128 nodules in total)who received treatment in Hanyang Hospital,Wuhan University of Science and Technology from January 2018 to February 2023 were selected for the study,and they were divided into benign group(n=50)and malignant group(n=45)according to the pathological examination results,and the general data of the two groups were compared.LASSO regression and multivariable logistic regression were used to analyze the risk factors affecting the nodule properties of patients.SR was divided into a 5-quartile array(Q1-Q5)from low to high.Clinical characteristics of the 5 groups were compared,and the correlation between SR and the risk of malignant nodules was analyzed with multivariable logistic regression.A restricted cubic spline Logistic regression model was established to analyze the dose-response relationship.The nonlinear association between SR and the risk of central lymph node metastasis of malignant thyroid nodules was analyzed by restricted cubic spline regression.The prediction model of regression equation y=1-1/(1+e-z)was established and verified.RESULTS There were significant differences in end-diastolic blood flow velocity(EDV),thyroid stimulating hormone(TSH),peak systolic blood flow velocity(PSV),resistance index(RI)and SR between benign and malignant groups(P<0.05).LASSO regression and multivariable logistic regression analysis showed that after adjusting for potential confounding factors,the increase of TSH,PSV,RI,and the decrease of EDV and SR were independent risk factors affecting the nodule features of the patients(P<0.05).There was an independent correlation between SR and the risk of malignant nodules(OR=0.60,95%CI 0.41-0.81,P<0.001),and the difference of SR from low to high quintile array trend test was statistically significant(Pfor tren

关 键 词：甲状腺结节 危险因素 甲状腺影像报告和数据系统 超声弹性应变率 

分 类 号：R581[医药卫生—内分泌]