主 办:北 京 中 医 药 大 学
ISSN 2095-6606 CN 10-1157/R

现代中医临床 ›› 2020, Vol. 27 ›› Issue (5): 7-13.doi: 10.3969/j.issn.2095-6606.2020.05.003

• 临床研究 • 上一篇    下一篇

甲状腺恶性结节超声鉴别的影响因素及中医证型与相关性分析董

董竞方1,2, 黄金昶2, 王媛媛3, 常青2#   

  1. 1 北京中医药大学 北京 100029;
    2 北京中医药大学第三附属医院;
    3 北京市东城区疾病预防控制中心
  • 收稿日期:2020-04-19 出版日期:2020-09-30 发布日期:2020-09-30
  • 通讯作者: # 常青,女,副主任医师,E-mail:changqing6666@aliyun.com
  • 作者简介:董竞方,女,主治医师

Influencing factors for malignant thyroid nodules with ultrasound identification and correlation between TCM syndromes and ultrasonographic manifestations

Dong Jingfang1,2, Huang Jinchang2, Wang Yuanyuan3, Chang Qing2#   

  1. 1 Beijing University of Chinese Medicine, Beijing 100029;
    2 Third Affiliated Hospital of Beijing University of Chinese Medicine;
    3 Beijing Dongcheng District Center for Disease Control
  • Received:2020-04-19 Online:2020-09-30 Published:2020-09-30

摘要: 目的 探讨甲状腺恶性结节超声鉴别的影响因素,分析甲状腺恶性结节中医证型与超声表现的相关性。方法 回顾性研究241例甲状腺结节患者,所有患者于北京中医药大学第三附属医院行超声检查并有病理金标准(包括穿刺病理和手术病理)做支持,分别采用单因素分析和多因素Logistic回归分析对甲状腺结节良恶性鉴别有影响的超声表现,及其影响程度。同时分析甲状腺恶性结节中医证型与超声表现之间的关系。结果 单因素分析显示:结节回声、边缘、纵横比、后方回声衰减、钙化这5个变量与结节良恶性有关(P<0.05);多因素Logistic回归分析显示:边缘、纵横比和钙化情况与结节良恶性有关(P<0.05),比较回归系数和OR值发现对良恶性的影响从大到小依次为:纵横比>钙化>边缘。70例恶性结节患者经中医分型,分别为22例肝郁气滞型,37例痰瘀互结型,11例瘀热伤阴型,3种中医证型超声表现相比,回声、边缘及钙化情况差异有统计学意义(P<0.05)。结论 边缘不规则、纵横比≥1和微小钙化或簇状钙化是甲状腺恶性结节的危险因素,其中纵横比≥1危险度最高,对甲状腺结节良恶性的鉴别贡献最大。在甲状腺恶性结节中,中医证型与超声表现有一定相关性,可为临床诊治提供参考依据。

关键词: 甲状腺结节, 良恶性, 超声, 影响因素, 中医证型

Abstract: Objective To explore the ultrasound-related factors influencing the diagnosis of malignant thyroid nodules, and to analyze the correlation between TCM syndromes and ultrasonographic manifestations in malignant thyroid nodules. Methods A retrospective study of 241 patients with thyroid nodules was conducted. All patients had undergone ultrasound examination at the third hospital affiliated to Beijing University of Chinese Medicine and the diagnosis was confirmed by pathological findings(including fine-needle aspiration biopsy and surgical pathology). Univariate analysis and multivariate Logistic regression analysis were used to analyze the ultrasonographic features that differentiated benign thyroid nodules from malignant ones. Meanwhile, the relationship between TCM syndromes and ultrasonographic manifestations of malignant thyroid nodules was analyzed. Results Univariate analysis showed that the five variables of nodules’echo, margin, aspect ratio, posterior attenuation, and calcification were related to benign and malignant (P<0.05); Multivariate Logistic regression analysis showed that the nodule’s edge, aspect ratio and calcification were related to benign and malignant (P<0.05). To compare the regression coefficient and the OR value, the effects on benign and malignant were as follows: aspect ratio>calcification>edge. 70 patients with malignant nodules were classified by TCM syndromes, including 22 cases of liver stagnation and qi stagnation, 37 cases of phlegm and blood stasis, 11 cases of static heat impairing yin. We compared the ultrasonographic manifestations of these three types of TCM syndromes, and the differences in echo, margin and calcification were statistically significant (P<0.05). Conclusions Irregular edge, aspect ratio≥1 and microcalcification or cluster calcification are the risk factors for malignant thyroid nodules. Among them, the aspect ratio≥1 is the highest risk, which contributes the most to the differentiation of benign and malignant thyroid nodules. TCM syndromes and ultrasonographic manifestations are correlated in malignant thyroid nodules, which can provide reference for clinical diagnosis and treatment.

Key words: thyroid nodules, benign and malignant, ultrasound, influencing factors, TCM syndromes

中图分类号: 

  • R265