炎症指标与甲状腺结节患者中医证型及结节C-TIRADS分类和性质的相关性研究  

Correlation of Inflammatory Indicators with Traditional Chinese Medicine Syndrome Types and C-TIRADS Classification and Properties of Nodules in the Patients with Thyroid Nodules

作　　者：李天昊 吉春兰 曾艳平 黄河清 陈元岩 李天翔 郭雄图 LI Tianhao;JI Chunlan;ZENG Yanping;HUANG Heqing;CHEN Yuanyan;LI Tianxiang;GUO Xiongtu(Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Guangzhou Integrated Chinese and Western Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine/Guangzhou Hospital of Intergrated Chinese and Western Medicine,Guangzhou 510800 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510006 [2]广州中医药大学附属广州中西医结合医院/广州市中西医结合医院,广东广州510800

出　　处：《广州中医药大学学报》2025年第3期552-559,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(编号:20171221);广州市花都区医疗卫生一般科研专项(编号:22-HDWS-088)。

摘　　要：【目的】分析甲状腺结节患者中性粒细胞与淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)、全身免疫炎症指数(SII)等炎症指标与不同中医证型及甲状腺结节超声恶性危险分层中国指南(C-TIRADS)分类和结节性质的相关性,为指导中医辨证及治疗提供依据,并为甲状腺结节患者的C-TIRADS分类及结节性质评估提供依据。【方法】回顾性分析2021年1月至2024年1月期间在广州中医药大学附属广州中西医结合医院(即广州市中西医结合医院)普外科住院诊断为甲状腺结节且行甲状腺切除术的140例患者。按照甲状腺结节不同中医证型、C-TIRADS分类、甲状腺结节性质分组,采用χ^(2)检验和秩和检验分析各项临床指标与中医证型及C-TIRADS分类和甲状腺结节性质的关系,采用Spearman相关系数分析临床指标与C-TIRADS分类和甲状腺结节性质的相关性,利用受试者工作特征(ROC)曲线分析NLR、MLR、PLR、SII等对甲状腺结节患者结节性质的预测价值,并以约登指数确定最佳预测临界值。【结果】(1)根据中医辨证分型标准,分为气郁痰阻证72例,痰结血瘀证65例,心肝阴虚证3例(由于心肝阴虚证的病例数太少,故不作分析)。(2)气郁痰阻证患者的游离T3(FT3)、游离T4(FT4)水平高于痰结血瘀证,抗甲状腺过氧化物酶抗体(A-TPO)、抗甲状腺球蛋白抗体(A-TG)、中性粒细胞(NEU)、NLR、SII水平低于痰结血瘀证,差异均有统计学意义(P<0.05或P<0.01)。(3)C-TIRADS3分类的NLR、PLR、SII水平低于C-TIRADS4分类,差异均有统计学意义(P<0.05或P<0.01);而C-TIRADS3分类与C-TIRADS4分类的MLR水平比较,差异无统计学意义(P>0.05)。(4)良性结节患者的NLR、PLR、MLR、SII水平均低于恶性结节患者,差异均有统计学意义(P<0.05或P<0.01)。(5)经Spearman相关性分析,NLR、PLR、SII与患者结节C-TIRADS分类呈正相关性,NLR、PLR、MLR、SII与患者结节�Objective To analyze the correlation of inflammatory indicators of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),monocyte-to-lymphocyte ratio(MLR),and systemic immune-inflammation index(SII)with traditional Chinese medicine(TCM)syndrome types and Chinese version of Thyroid Imaging Reporting and Data System(C-TIRADS)classification and properties of nodules in the patients with thyroid nodules(TN),thus to provide evidence for guiding TCM syndrome differentiation and treatment,and for assessing C-TIRADS classification and properties of the nodules in patients with TN.Methods A retrospective analysis was carried out in 140 inpatients who were diagnosed as TN and had underwent thyroidectomy during the period of January 2021 to January 2024 in the Department of General Surgery of Guangzhou Integrated Chinese and Western Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine(Guangzhou Hospital of Integrated Traditional and West Medicine).The patients were allocated to various group with reference to TCM syndrome types,C-TIRADS classification,and the properties of TN.The correlation of each clinical indicator with TCM syndrome types and C-TIRADS classification and properties of TN was analyzed.The Spearman correlation coefficient was employed for evaluating the correlation of clinical indicators with the C-TIRADS classification and properties of TN,receiver operating characteristic curve(ROC)was used to analyze the predictive value of NLR,MLR,PLR,and SII for the properties of nodules in patients with TN,and the Youden s Index was used to determine the cutoff value for optimal prediction.Results(1)According to the criteria of TCM syndrome differentiation,72 cases were differentiated as qi stagnation and phlegm obstruction syndrome,65 cases as phlegm accumulation and blood stasis syndrome,and 3 cases as heart-liver yin deficiency syndrome.For the number of cases of heart-liver yin deficiency syndrome was too small,only the first two syndromes were included for the analysis.(2)The l

关 键 词：甲状腺结节 C-TIRADS分类 结节性质 中医证型 气郁痰阻证 痰结血瘀证 中性粒细胞与淋巴细胞比值 NLR 血小板淋巴细胞比值 PLR 单核细胞与淋巴细胞比值 MLR 全身免疫炎症指数 SII 

分 类 号：R265[医药卫生—中医外科学]