CAJ | 학술논문

目的：研究及分析不同性质甲状腺结节的临床特征,提供结节良恶性的准确信息,更好地评价和诊断甲状腺结节。方法收集华中科技大学同济医学院附属协和医院2011年2~5月205例因甲状腺结节手术切除患者资料,分析良恶性结节的临床基本资料、超声影像资料、激素水平(游离三碘甲状腺原氨酸 FT3、游离甲状腺素 FT4、促甲状腺激素TSH)及免疫学指标。结果205例病例中(男34例,女171例),男女性患者结节中恶性病变各占50.0%、34.5%,差异无统计学意义(P>0.05)。病理诊断良性结节129例(62.9%),其中结节性甲状腺肿113例；恶性结节76例(37.1%),其中乳头状癌72例。超声影像特点：结节内低回声,良性结节(20.2%)和恶性结节(46.1%)比较(P<0.01)；结节内血流,良性结节(59.7%)和恶性结节(75.0%)比较(P<0.05)；结节内微钙化,良性结节(24.0%)和恶性结节(51.3%)比较(P<0.01),差异均有统计学意义。激素水平及免疫学特点：FT4水平升高与甲状腺结节恶性发生率呈负相关(P<0.05,OR=0.827)；恶性结节中抗体滴度增高的比例显著高于良性结节,17.2% vs.4.03%(TPOAb),23.4%vs.11.3%(TGAb),15.6%vs.3.2%(TPOAb并 TGAb),差异均有统计学意义(均P<0.01)。伴有 TPOAb、TGAb 水平升高的甲状腺结节为恶性的比例显著高于 TPOAb、TGAb 正常者(68.7% vs.30.8%,51.7% vs.30.8%)。结论尽管甲状腺结节多见于女性,但男性甲状腺结节可能更倾向于恶变。结节内低回声、结节内血流、结节内微钙化均提示高度恶性风险。FT4水平的升高对降低甲状腺结节恶性概率有一定意义。TPOAb、TGAb 升高是甲状腺结节的恶性危险因素。
목적：연구급분석불동성질갑상선결절적림상특정,제공결절량악성적준학신식,경호지평개화진단갑상선결절。방법수집화중과기대학동제의학원부속협화의원2011년2~5월205례인갑상선결절수술절제환자자료,분석량악성결절적림상기본자료、초성영상자료、격소수평(유리삼전갑상선원안산 FT3、유리갑상선소 FT4、촉갑상선격소TSH)급면역학지표。결과205례병례중(남34례,녀171례),남녀성환자결절중악성병변각점50.0%、34.5%,차이무통계학의의(P>0.05)。병리진단량성결절129례(62.9%),기중결절성갑상선종113례；악성결절76례(37.1%),기중유두상암72례。초성영상특점：결절내저회성,량성결절(20.2%)화악성결절(46.1%)비교(P<0.01)；결절내혈류,량성결절(59.7%)화악성결절(75.0%)비교(P<0.05)；결절내미개화,량성결절(24.0%)화악성결절(51.3%)비교(P<0.01),차이균유통계학의의。격소수평급면역학특점：FT4수평승고여갑상선결절악성발생솔정부상관(P<0.05,OR=0.827)；악성결절중항체적도증고적비례현저고우량성결절,17.2% vs.4.03%(TPOAb),23.4%vs.11.3%(TGAb),15.6%vs.3.2%(TPOAb병 TGAb),차이균유통계학의의(균P<0.01)。반유 TPOAb、TGAb 수평승고적갑상선결절위악성적비례현저고우 TPOAb、TGAb 정상자(68.7% vs.30.8%,51.7% vs.30.8%)。결론진관갑상선결절다견우녀성,단남성갑상선결절가능경경향우악변。결절내저회성、결절내혈류、결절내미개화균제시고도악성풍험。FT4수평적승고대강저갑상선결절악성개솔유일정의의。TPOAb、TGAb 승고시갑상선결절적악성위험인소。
Objective To investigate the clinical characteristics of thyroid nodules of different nature,provide accurate in-formation on benignancy and malignancy of these nodules,and better evaluate and diagnose thyroid nodules.Methods Clinical data were collected of 205 patients with thyroid nodules who had their thyroid nodules resected in Union Hospital,Tongji Medi-cal College of Huazhong University of Science and Technology between Feb.and May 2011.The basic clinical data,ultrasono-graphic data,hormone levels(FT3,FT4 and TSH)and immunological indicators were analyzed.Results Among the 205 pa-tients(34 males and 171 females),the malignant lesions accounted for 50.0% in men and 34.5% in women and there was no significant difference(P>0.05).Pathological examination revealed that there were 129 cases of benign nodules(62.9%),among which 113 cases were nodular goiter,and there were 76 cases of malignant nodules(37.1%),among which,72 cases were papil-lary thyroid carcinoma.Analysis of ultrasonographic characteristics of thyroid nodules showed that the hypoechoic rate was 20.2% in benign nodules and 46.1% in malignant nodules(P<0.01);the visible blood flow rate was 59.7% in benign nod-ules,and 75.0% in malignant nodules(P<0.05);the micro-calcification rate was 24.0% in benign nodules and 51.3% in ma-lignant nodules(P<0.01).Furthermore,the elevated serum level of FT4 was negatively correlated with the malignancy rate of thyroid nodules(P<0.05,OR=0.827).In addition,patients with malignant thyroid nodules tended to have higher levels of thyroglobulin antibody(TGAb)and thyroid peroxidase antibody(TPOAb)than those with benign thyroid nodules(TPOAb:17.2%vs.4.03%;TGAb:23.4%vs.11.3%;TPOAb and TGAb:15.6% vs.3.2%)and significant differences were noted in the levels of the two antibodies between malignant and benign thyroid nodules(P<0.01 for all).The proportion of malignant nodules was higher in patients with elevated TPOAb and TGAb than in those with normal levels(68.7% vs.30.8%,51.7%vs.30.8%).Conclusion Although thyroid nodules are more common in women,men are predisposed to malignant nod-ules.The hypoecho,visible blood flow and micro-calcification indicate high risk of malignancy.The elevated serum level of FT4 is negatively associated with the malignancy of nodules.The elevated TPOAb/TGAb levels are risk factors of malignant thyroid nodules.