中国老年人群甲状腺结节风险动态监测指标的建立  

Establishing monitoring parameters for Chinese elderly patients with risk thyroid nodules undergoing active surveillance

作　　者：窦赟喆 李建坤 王飞亮 缪刚[1,2] DOU Yunzhe;LI Jiankun;WANG Feiliang;MIAO Gang(Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730;Department of General Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730;Department of Ultrasonography,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院、国家老年医学中心、北京协和医学院、中国医学科学院,100730 [2]北京医院普通外科、国家老年医学中心、中国医学科学院老年医学研究院,100730 [3]北京医院超声医学科、国家老年医学中心、中国医学科学院老年医学研究院,100730

出　　处：《中国老年保健医学》2024年第6期19-24,共6页Chinese Journal of Geriatric Care

基　　金：北京医院临床研究121工程项目(编号:BJ-2220-169)。

摘　　要：目的评估与老年甲状腺结节风险患者动态监测相关的指标。方法本研究为回顾性队列研究,纳入在北京医院进行动态随访的老年高危甲状腺结节患者。对这些患者每3~6个月进行1次甲状腺超声检查和甲状腺功能检查,对于出现疾病进展或患者意愿改变的病例,建议进行手术干预。本研究纳入并评估了动态监测过程中的指标,包括患者的人口统计学特征、C-TIRADS分类、超声特征、手术信息和组织病理特征。结果排除数据缺失的患者,共纳入273例(287个C-TIRADS 4类结节)老年患者,平均年龄66.9岁,79.4%为女性。随访时间为28~94个月,平均31个月。在动态监测期间,共有31例患者(34个结节)接受了手术,其中21个结节有恶性病理结果。超声形态不规则(P=0.008)、新发可疑淋巴结(P=0.01)、C-TIRADS分类升高与恶性结节相关(P<0.001)。结论结节超声下形态不规则、出现新发可疑淋巴结及C-TIRADS分类升高可作为动态监测指标,有效识别需要手术干预的结节。本研究强调了动态监测作为老年甲状腺风险结节管理策略之一的潜在可能性。Objective This study aims to assess the monitoring parameters associated with active surveillance in elderly individ-uals with risk nodules.Methods We conducted a retrospective study,including elderly patients with risk thyroid nodules,who un-derwent active surveillance by ultrasound examinations.Surgical intervention was recommended for cases with disease progression or preference changing.The study encompassed a comprehensive monitoring process,which included patient demographics,C-TIRADS classifications,ultrasonic features and histopathological diagnoses.Results Excluding patients with data missing,analysis was con-ducted on a cohort of 273 elderly patients with 287 risk nodules,mean age is 66.9 years,the proportion of women is 79.4%.During a mean surveillance period of 31 months,31 patients with 34 nodules underwent surgery.Among these nodules,21 nodules were diag-nosed as malignance.We observed that irregular morphology under ultrasound(P=0.008),the emergence of new suspicious lymph nodes(P=0.01),and an elevation in the C-TIRADS category(P<0.001)are associated with malignant nodules.Conclusion Ir-regular morphology,the appearance of suspicious lymph nodes and an elevation in the C-TIRADS category could be the monitoring parameters,which effectively identify nodules that may need surgical intervention.Our study underscored the potential effectiveness of active surveillance as a management strategy for risk thyroid nodules in the Chinese elderly.

关 键 词：老年 甲状腺结节 动态监测 

分 类 号：R73[医药卫生—肿瘤]