甲状腺超声检查联合甲状腺功能指标在良恶性甲状腺结节中的诊断价值

Diagnostic Value of Thyroid Ultrasound Combined with Thyroid Function in Benign and Malignant Thyroid Nodules

目的探讨甲状腺超声检查联合甲状腺功能指标在良恶性甲状腺结节中的诊断价值。方法方便选取2015年3月—2018年3月该院收治的73例甲状腺结节患者,以术后病理结果为依据将其分为良性组(n=52)和恶性组(n=21),全部患者术前均行超声检查,比较恶两组患者甲状腺结节超声形态、血流信号等征象情况,对比甲状腺功能指标水平,包括促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)、三碘甲状原氨酸(T3)、甲状腺素(T4)、抗甲状腺球蛋白抗体(TGA)和抗甲状腺过氧化物酶抗体(TPO-Ab),以病理结果为金标准分析TSH、超声和超声+TSH诊断恶性结节的准确性。结果恶性组淋巴肿大、钙化、回声、边界不清、形态不规则、血流分级Ⅱ级、Ⅲ级发生率(19.05%、57.14%、85.71%、47.62%、71.43%、57.14%、28.57%)均明显高于良性组(1.92%、19.23%、32.69%、17.31%、26.92%、19.23%、7.69%)(χ~2=4.453、10.212、16.850、7.139、8.936、10.212、3.891,P=0.035、0.001、0.000、0.008、0.003、0.036、0.048),血流Ⅰ级发生率(14.29%)明显低于良性组(61.54%)(χ~2=13.383,P=0.000);恶性组TSH、T3、T4、TPO-Ab水平明显高于良性组(P<0.05)(χ~2=8.441、3.817、6.337、3.919,P=0.000、0.000、0.000、0.030),TT3、TGA水平明显低于良性组(χ~2=4.533、4.722,P=0.000、0.045);TSH诊断恶性甲状腺结节的敏感性、特异性、准确性、漏诊率、误诊率依次为53.8%、57.1%、54.8%、46.2%、42.9%,超声依次为61.5%、66.7%、63.0%、38.5%、33.3%,超声+TSH依次为86.5%、85.7%、86.3%、13.5%、14.3%,组间数据比较差异有统计学意义(F=9.916、10.175、12.310、8.198、7.539,P=0.000、0.000、0.000、0.000、0.000)。结论甲状腺超声检查联合甲状腺功能指标在良恶性甲状腺结节中具有重要的临床诊断价值,可有效改善恶性结节漏诊、误诊情况,提高临床诊断准确性。

Objective To investigate the diagnostic value of thyroid ultrasound combined with thyroid function in benign and malignant thyroid nodules. Methods 73 patients with thyroid nodules admitted to the hospital from Match 2015 to March 2018 were enrolled. The pathological results were convenient divided into benign group （n=52） and malignant group （n=21）. All patients underwent ultrasonography before surgery to compare the signs of thyroid nodules with ultrasound mor- phology and blood flow signals, and to compare thyroid function indicators, including thyroid stimulating hormone （TSH） and total triiodothyronine （TT3）, triiodothyronine （T3）, thyroxine （T4）, anti-thyroglobulin antibody （TGA） and anti-thyroid perox- idase antibody （TPO-Ab）, TSH, ultrasound analysis of pathological results as gold standard and ultrasound ＋ TSH to diag- nose the accuracy of malignant nodules. Results Malignant lylnphadenopathy, calcification, echo, unclear boundary, irregu- lar shape, grade II and III of blood flow classification （19.05%, 57.14%, 85.71%, 47.62%,71.43%, 57.14%, 28.57%） were significantly higher than the benign group （1.92%, 19.23%, 32.69%, 17.31%, 26.92%, 19.23%, 7.69%） （X2=4.453, 10.212, 16.850, 7.139, 8.936, 10.212, 3.891, P=0.035 , 0.001, 0.000, 0.008, 0.003, 0.036, 0.048）, the incidence of blood flow grade I （14.29%） was significantly lower than that of the benign group （61.54%） （X2=13.383, P=0.000）; malignant group TSH, T3, T4 The level of TPO-Ab was significantly higher than that of the benign group （P〈0.05） （X2=8.441, 3.817, 6.337, 3.919, P= 0.000, 0.000, 0.000, 0.030）, and the TT3 and TGA levels were significantly lower than the benign group （X2=4.533, 4.722, P=0.000, 0.045）; TSH diagnosis of malignant thyroid nodules sensitivity, specificity, accuracy, missed diagnosis rate, misdi- agnosis rate were 53.8%, 57.1%, 54.8%, 46.2%, 42.9%, followed by ultrasound 61.5%, 66.7%, 63.0%, 38.5%, 33.3%, ul- trasound ＋ TSH were 86.5%, 85.7%, 86.3%, 13.5%, 14.3%, respectively. The difference between the groups was statistical-ly significant （F=9.916, 10.175, 12.310, 8 .198, 7.539;P=0.000, 0.000, 0.000, 0.000, 0.000）. Conclusion Thyroid ultrasonography combined with thyroid function has important clinical diagnostic value in benign and malignant thyroid nodules, which can effectively improve the diagnosis and misdiagnosis of malignant nodules and improve the accuracy of clinical diagnosis.