超声影像学特征联合TgAb、TSH鉴别甲状腺结节良恶性的价值  

Value of ultrasound imaging features combined with TgAb and TSH for differentiating benign and malignant thyroid nodules

作　　者：杨金艳 马哲 徐华 Yang Jinyan;Ma Zhe;Xu Hua(Department of Ultrasound,Shaanxi Hospital of Traditional Chinese Medicine,Xi'an 710082,China;Department of B-scan Ultrasonography,Shaanxi Hospital of Traditional Chinese Medicine,Xi'an 710082,China)

机构地区：[1]陕西省中医医院超声科,西安710082 [2]陕西省中医医院B超室,西安710082

出　　处：《国际医药卫生导报》2025年第8期1311-1315,共5页International Medicine and Health Guidance News

基　　金：国家卫健委“十四五”规划全国重点课题(YWS4188)。

摘　　要：目的分析超声影像学特征联合甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)及促甲状腺激素(thyroid stimulating hormone,TSH)在鉴别甲状腺结节(thyroid nodule,TN)良恶性中的应用价值。方法选取2021年5月至2024年6月陕西省中医医院收治的85例TN患者,其中男42例,女53例。均行超声检查,采用全自动化学发光分析仪检测患者血清TgAb、TSH水平。根据病理检查结果分为良性结节组和恶性结节组,比较两组患者超声影像学特征及TgAb、TSH水平。采用t、χ^(2)检验进行统计比较,二元logistic逐步回归模型分析恶性TN的影响因素,受试者操作特征曲线(ROC)分析超声影像学特征联合TgAb、TSH在TN良恶性中的鉴别价值。结果85例TN患者,共95个结节,其中良性结节69个(72.63%),包括结节型甲状腺肿瘤51个、腺瘤12个、炎症6个;恶性结节26个(27.37%),包括乳头状癌22个、髓样癌2个、滤泡样癌2个。恶性结节组和良性结节组结节最大径、形态、血流分级、TgAb与TSH水平比较,差异均有统计学意义(均P<0.05)。二元logistic回归分析,结节最大径>10 mm[比值比(OR)=5.513,置信区间(95%CI)(1.960~15.505)]、形态不规则(OR=4.807,95%CI 1.814~12.739)、血流分级2~3级(OR=3.960,95%CI 1.506~10.412)、TgAb水平(OR=1.076,95%CI 1.036~1.117)、TSH水平(OR=2.635,95%CI 1.627~4.270)是诊断TN患者恶性的影响因素(均P<0.05)。ROC显示,结节最大径>10 mm、形态不规则、血流分级2~3级、TgAb、TSH水平及联合诊断TN患者恶性的灵敏度分别为0.769、0.692、0.692、0.808、0.731、0.885,特异度分别为0.623、0.681、0.638、0.623、0.638、0.870。联合诊断TN患者恶性的价值较高(曲线下面积为0.881)。结论超声影像学特征联合TgAb、TSH诊断TN患者恶性的价值较高,可提升诊断鉴别效能。Objective To analyze the ultrasound imaging features combined with thyroglobulin antibody(TgAb)and thyroid stimulating hormone(TSH)for differentiating benign and malignant thyroid nodules.Methods A total of 85 patients with thyroid nodules admitted to Shaanxi Provincial Hospital of Traditional Chinese Medicine from May 2021 to June 2024 were selected as the study objects,Among them,42 were males and 53 were females.All the patients underwent ultrasound examination.The serum levels of TgAb and TSH were detected by the automatic chemiluminescence analyzer.According to the pathological examination results,the patients were divided into a benign nodule group and a malignant nodule group.The ultrasound imaging features and levels of TgAb and TSH were compared between the two groups.t andχ^(2) tests were used for the statistical analysis.The influence factors of malignancy in the patients were analyzed by the binary logistic step-by-step regression model.The value of ultrasound imaging features combined with TgAb and TSH for differentiating benign and malignant thyroid nodules was analyzed by the receiver operating characteristic curve(ROC).Results There were 95 nodules in the 85 patients;there were 69 benign nodules(72.63%),including 51 nodular thyroid tumors,12 adenomas,and 6 inflammatory nodules;there were 26 malignant nodules(27.37%),including 22 papillary carcinoma,2 medullary carcinoma,and 2 follicular carcinoma.There were statistical differences in the nodule maximum diameter,shape,blood flow grading,and levels of TgAb and TSH between the two groups(all P<0.05).The binary logistic regression analysis showed that the nodule maximum diameter>10 mm[OR=5.513(95%CI 1.960-15.505)],irregular shape[OR=4.807(95%CI 1.814-12.739)],grade 2-3 blood flow[OR=3.960(95%CI 1.506-10.412)],TgAb level[OR=1.076(95%CI 1.036-1.117)],and TSH level[OR=2.635(95%CI 1.627-4.270)]were the influential factors for diagnosing malignancy in the patients(all P<0.05).The ROC showed that the sensitivities of nodule maximum diameter>10 mm,irregular

关 键 词：甲状腺结节 超声影像学特征 甲状腺球蛋白抗体 促甲状腺激素 鉴别 

分 类 号：R581[医药卫生—内分泌]