甲状腺结节超声特征与中医证型相关性分析

Correlation Analysis Between Ultrasonic Characteristics of Thyroid Nodules and Chinese Medicine Syndrome Types

目的:探讨甲状腺结节超声特征与中医辨证分型的相关性。方法:纳入行甲状腺超声检查并检出甲状腺结节患者,判定其中医证型,超声检查记录甲状腺结节数量、较大结节最大径及平均径、结节成分、结节回声类型、结节内部回声均匀与否、结节形态、结节边缘、结节钙化、结节血流信号等信息,并根据ACR TI-RADS分类标准分级;统计分析不同中医证型的各项甲状腺超声特征之差异。结果:纳入合格病例311例,其中痰结血瘀证148例,痰湿蕴结证93例,气郁痰阻证70例。3组证型甲状腺结节边缘、形态(纵横比)、钙化比较,差异有统计学意义(P<0.05),表现为气郁痰阻证组甲状腺结节呈分叶状或不规则(24.3%)、纵横比>1(27.1%)、伴钙化(37.1%),这3项超声特征的检出率均比其他2组高(P<0.05);3组证型甲状腺结节数量、较大结节的最大径、平均径及结节成分、回声类型、回声均匀与否、血流信号之间的比较未发现明显差异(P>0.05)。3组证型间结节ACR TI-RADS分类比较,差异有统计学意义(P<0.05);两两比较发现,气郁痰阻证组与痰结血瘀证组、痰湿蕴结证组甲状腺结节ACR TI-RADS分类比较,差异有统计学意义(P<0.05),表现为气郁痰阻证组的ACR TI-TADS分类集中在TR4、TR5,而痰结血瘀证组、痰湿蕴结证组的ACR TI-RADS分类集中于TR3、TR4。痰结血瘀证组和痰湿蕴结证组ACR TI-TADS分类比较,差异无统计学意义(P>0.05)。结论:甲状腺结节超声特征与中医证型之间存在着一定的相关性;气郁痰阻证组甲状腺结节以结节呈分叶状或形态不规则、纵横比>1及可见钙化为多见,ACR TI-RADS分类评分也较高。

Objective:To discuss the correlation between ultrasonic characteristics of thyroid nodules and Chinese medicine syndrome differentiation typing.Methods:Patients who were examined by the thyroid ultrasonography and diagnosed with thyroid nodules were enrolled,and their Chinese medicine syndrome types were determined.Information related to thyroid nodules such as the number,the maximum diameter and the average diameter of larger nodules,the composition,echo pattern,homogeneity of internal echo,morphology,margin,calcification and blood flow signals were recorded through ultrasonography,and the above information was classified based on ACR TI-RADS.The differences of each ultrasonic characteristic of thyroid nodules in different Chinese medicine syndrome types were counted and analyzed.Results:Among enrolled 311 eligible cases,there were 148 cases with phlegm retention and blood stasis syndrome,93 cases with phlegm-dampness accumulation syndrome,and 70 cases with qi constraint and phlegm obstruction syndrome.There was significant difference being found in the comparison of margin,morphology named aspect ratio and calcification of thyroid nodules in the three groups with different syndromes(P<0.05);there was lobulated or irregular thyroid nodules,the aspect ratio more than one and calcification in the group with qi constraint and phlegm obstruction syndrome,accounting for24.3%,27.1%and 37.1%respectively,and the detection rate of the three ultrasonic characteristics was higher than that in the other two groups(P<0.05).There was no significant difference being found in the comparison of the number of thyroid nodules,the maximum diameter of larger nodules,the average diameter and the composition of nodules,echo pattern,homogeneity of echo and blood flow signals in the three groups with different syndromes(P>0.05).There was significant difference being found in the comparison of ACR TI-RADS classification of nodules in the three groups with different syndromes(P<0.05).When compared ACR TI-RADS classification of thyroid nodules among the groups with qi constraint and phlegm obstruction syndrome,phlegm retention and blood stasis syndrome and phlegm-dampness accumulation syndrome,the difference among the groups was significant(P<0.05);ACR TI-TADS classification centered on TR4 and TR5 in the group with qi constraint and phlegm obstruction syndrome,and TR3 and TR4 were the centers of classification in the groups with phlegm retention and blood stasis syndrome and phlegm-dampness accumulation syndrome.There was no significant difference being found in the comparison of ACR TI-TADS classification between the groups with phlegm retention and blood stasis syndrome and phlegm-dampness accumulation syndrome(P>0.05).Conclusion:There is certain correlation between ultrasonic characteristics of thyroid nodules and Chinese medicine syndrome types.In the group with qi constraint and phlegm obstruction syndrome,lobulated or irregular thyroid nodules,the aspect ratio more than one and visible calcification are more common,and the score of ACR TI-RADS classification is higher.