甲状腺结节发生的危险因素分析

Risk factors of thyroid nodules

目的 探讨影响甲状腺结节发生的相关危险因素，为预防该疾病的发生提供科学依据。方法 以2012年1月至2014年12月在 山西省地方病防治研究所附属医院体检者共220人作为研究对象，采用病例对照研究设计，以经彩色多普勒超声检查及病理证实的 甲状腺结节患者为病例组，以超声检查及甲状腺功能检查均正常者作为对照组。采用问卷调查法收集研究对象一般人口学资料、疾 病家族史，甲状腺功能检测结果，并比较两组人群在一般情况、生活习惯、家族史、临床检验结果的差异，并根据结果进行多因素 非条件logistic回归分析，找出影响甲状腺结节发生的危险因素，计算比值比（OR）。结果 共收集有效问卷209份，问卷有效率为 95.00%（209／220），平均年龄为（42.28 ± 11.86）岁，男女比例为1.0 ∶ 5.3（33 ∶ 176）。病例组与对照组不同年龄、性 别和体质指数（BMI）、是否使用染发剂、总三碘甲状腺原氨酸（TT3）、血清游离甲状腺素（FT4）、促甲状腺激素（TSH）、抗甲 状腺微粒体抗体（TMAb）比较差异均有统计学意义（P均 ＜ 0.05）。将年龄、性别、BMI、使用染发剂、TT3、FT4、TSH、TMAb放 入logistic回归模型调整后，结果显示，年龄每增加1岁，发生甲状腺结节的风险将会增加9.7%［OR = 1.097，95%置信区间（CI） ：1.017 - 1.183］；女性发生甲状腺结节的风险是男性的3.214倍（OR = 3.214， 95%CI：1.025 - 5.923）；TSH每增高1个等级 ，患病风险增加1.030倍（OR = 2.030，95%CI：1.050 - 3.922）；TMAb平均每增加1%，患病风险增加28.3%（OR = 1.283，95%CI ：1.076 - 1.529）。结论 女性患甲状腺结节的风险高于男性；年龄增加、TSH和TMAb的水平上升也会增加患甲状腺结节的风险。

Objective To investigate the factors affecting the occurrence of thyroid nodules, and to offer scientific methods to prevent the occurrence of this disease. Methods A total of 220 subjects were involved in the study from January 2012 to December 2014 at the Affiliated Hospital of Shanxi Institute for Endemic Disease Prevention and Treatment. A case-control study was designed. The case group with thyroid nodules was confirmed by color Doppler ultrasonography and pathology. The control group, at the same time, was confirmed by ultrasound and thyroid function tests. Face to face questionnaire was used to collect the demographic data, family history of disease and thyroid function test results. The differences in general conditions, living habits, family history, and clinical test results were compared between the two groups. Finally, multivariate logistic regression model was used to analyze risk factors, which may affect the occurrence of thyroid nodules, odds ratio （OR） was calculated. Results This study collected 209 valid samples. The rate of valid samples was 95.00% （209/220）. The average age was （42.28 ± 11.86） years old, and the ratio of male to female was 1.0 ∶ 5.3 （33 ∶ 176）. There were significant differences in age, sex, body mass index （BMI）, the use of hair dye, total thyroid thyroxine （TT3）, serum free thyroxine （FT4）, and thyroid-stimulating hormone （TSH）, anti-thyroid microsomal antibodies （TMAb） between the case group and the control group （P 〈 0.05）. Those variables, which were significant in single factor analysis such as age, gender, BMI, hair dye, TT3, FT4, TSH and TMAb, were put into the logistic model to adjust confounding. After that, the results suggested that the risk increased 9.7% [OR： 1.097, 95% confidence interval （CI）： 1.017 - 1.183] with increase in age by one year. Women were 3.214 times （OR： 3.214, 95%CI： 1.025 - 5.923） more likely to have thyroid nodules. TSH increased by 1 level, the risk increased by 1.030 times （OR： 2.030, 95%CI： 1.050 - 3.922）. TMAb increased by 1% on average, an increase in the risk of disease by up to 28.3% （OR = 1.283,95%CI：1.076 - 1.529）. Conclusions Women are at higher risk of thyroid nodules than men. And older age, high levels of TSH and TMAb also increase the risk of thyroid nodules.