合肥市社区常住居民糖代谢异常人群中甲状腺结节患病特点及影响因素的分析

Analysis of the characteristics of thyroid nodules and risk factors of thyroid nodules in glycometabolism disorders of population in Hefei communities

目的探讨合肥市社区常住居民不同糖代谢人群中甲状腺结节的患病特点及其影响因素。方法从合肥市包河区常青社区1 425例年龄大于18岁的常住居民中,根据随机数据表法,随机抽取388例作为本研究对象。所有受试者行75g口服葡萄糖耐量检查(75g-OGTT)。根据血糖水平将受试者分为糖代谢正常组(NGM组)、糖代谢异常组(AGM组),两组均完成有关临床资料的收集、实验室指标的检测以及甲状腺B超的检查。并应用多因素Logistic回归分析,探讨影响甲状腺结节发生的相关因素。结果 (1)AGM组的体质指数、腰围、收缩压、空腹血糖、75 g-OGTT后2 h血糖、糖化血红蛋白A1c、血三酰甘油、总胆固醇、低密度脂蛋白胆固醇、血尿酸水平、甲状腺过氧化物酶抗体阳性率、甲状腺球蛋白抗体阳性率均显著高于NGM组(P<0.05),高密度脂蛋白胆固醇显著低于NGM组(P<0.05)。(2)AGM组甲状腺结节总检出率为27.5%,多发甲状腺结节的检出率为7.3%,均高于NGM组(P<0.05)。两组间甲状腺单发结节、左叶结节、右叶结节、两叶结节、直径大于1 cm结节、伴钙化及强回声结节的检出率,差异均无统计学意义。(3)多因素Logistic回归分析结果显示,血尿酸水平、尿碘中位数、甲状腺抗体水平、糖代谢异常状态为甲状腺结节发生的独立影响因素,可增加甲状腺结节的发病风险(P<0.05)。结论合肥市常住居民糖代谢异常人群中甲状腺结节发病风险增加,开展甲状腺结节早期筛查以及采取相应干预措施很有必要。

Objective To investigate the characteristics of thyroid nodules and risk factors of thyroid nodules in glycometabolism disorders of population in Hefei communities.Methods According to random data table method,a total of 388 subjects were randomly selected as the objects of this research from 1 425 permanent residents aged18 years or older from Changqing community of Baohe district in Hefei city,and all underwent a 75 g oral glucose tolerance test（OGTT）.They were divided into normal blood glucose group（NGM group） and abnormal glucose metabolism group（AGM group） by blood glucose levels.Clinical data,laboratory examination results,and thyroid B-ultrasonic examination were recorded.The multiple Logistic regression analysis were performed to assess the related risk factors for thyroid nodule.Results（1） Compared with individuals in NGM group,body mass index,waistline,systolic blood pressure,fasting plasma glucose,two-hour plasma glucose during OGTT,glycosylated hemoglobin A1 c,triglyceride,total cholesterol,low-density lipoprotein-cholesterol,serum uric acid levels,positive rate of thyroid peroxidase antibody as well positive rate of thyroglobulin antibody were significantly higher in individuals than in NGM group（P0.05）.In contrast,high-density lipoprotein-cholesterol were significantly lower in individuals than in NGM group（P0.05）.（2） The detection rates of thyroid nodule and multiple nodules in AGM group were 27.5%,7.3%,respectively,which were all higher in AGM group than in NGM group（P0.05）.However,there were not significant difference in the detection rates of solitary thyroid nodule,left leaf nodule,right leaf nodule,two leaft nodule,nodule longer than 1 cm,thyroid nodule with calcification and dense echo between AGM group and NGM group.（3） Multivariate Logistic regression analysis showed that serum uric acid level,median urinary iodine,thyroid antibody level and abnormal glucose metabolism were independently associated with a statistically significant increase in the risk of thyroid nodule（P0.05）.Conclusion Abnormal glucose metabolism increases the risk of thyroid nodule in Hefei communities.It is necessary to carry out thyroid nodule screening and take appropriate intervention measures in individuals with abnormal glucose metabolism.