超声引导下聚桂醇治疗甲状腺囊性结节疗效的影响因素

Factors Influencing Therapeutic Effects of Ultrasound-Guided Lauromacrogol Sclerotherapy for Cystic Thyroid Nodules

目的 探讨影响聚桂醇硬化治疗甲状腺囊性结节近、远期疗效的因素。资料与方法 连续纳入2017年11月—2020年10月北京医院门诊及病房收治的74例共76个甲状腺囊性结节,均接受超声引导下细针抽吸活检、囊液甲状腺球蛋白(Tg)浓度检测和聚桂醇硬化治疗,并于术后3个月和12个月进行超声随访。以囊肿初始体积、囊壁血供情况、病理类型及囊液Tg浓度作为疗效评价指标。采用重复测量方差分析评估结节体积变化,采用二元Logistic回归分析疗效的影响因素,采用受试者工作特征曲线确定Tg浓度评估治疗有效性的阈值。结果 治疗后囊肿体积随着随访时间延长呈缩小趋势,不同随访时间结节体积(F=34.58,P<0.001)及体积缩小率(F=161.36,P<0.001)差异均有统计学意义。术后3个月有效率为81.58%(62/76),术后12个月累积有效率为97.33%(73/75),治愈率为81.33%(61/75)。囊液Tg浓度是术后3个月治疗有效率(OR=0.997,P=0.003)及术后12个月治愈率的影响因素(OR=0.998,P=0.031)。以囊液Tg浓度146.50 ng/ml作为术后3个月有效性截断值,受试者工作特征曲线下面积为0.81,特异度为0.86。结论 超声引导下聚桂醇注射可有效治疗甲状腺囊性结节,囊液Tg浓度是甲状腺囊性结节硬化治疗近期及远期疗效的影响因素。

Purpose To investigate the factors influencingthe short-term and long-term efficacy of lauromacrogol sclerotherapy for cystic thyroid nodules.Materials and Methods From November 2017 to October 2020,76 cystic thyroid nodules of 74 cases at the outpatient clinic and the ward of Beijing Hospital were enrolled consecutively and retrospectively.All nodules underwent ultrasound-guided fine-needle aspiration biopsy,detection of thyroglobulin(Tg)-FNA concentration in cystic fluid,lauromacrogol sclerotherapy,and follow-up survey by ultrasound at 3 months and 12 months after operation.Nodule volume,blood supply of nodule wall,pathological type and Tg-FNA concentration were set as related factors.Repeated measure analysis was used to assess nodule volume changes.Binary Logistic regression was used to determine the variables.Receiver operating characteristic curve analysis was conducted to determine the most appropriate cutoff value for Tg-FNA.Results The volume of cystic thyroid nodules tended to shrink with follow-up.There were statistically significant differences in nodule volume(F=34.58,P<0.001)and the volume reduction rate(F=161.36,P<0.001)during distinct follow-up times.The resolution rate was 81.58%(62/76)at 3 months,97.33%(73/75)and cured rate was 81.33%(61/75)at 12 months after the procedure.Tg-FNA concentration was slightly negatively related to the short-term(OR=0.997,P=0.003)and long-term(OR=0.998,P=0.031)prognosis.The area under the receiver operating characteristic curve at 3 months was 0.81.With a cutoff value of Tg-FNA concentration 146.50 ng/ml,the specificity was 0.86.Conclusion The percutaneous lauromacrogol injection therapy for cystic thyroid nodules has obvious therapeutic effect.Tg-FNA concentration can be recognized as an influence factor of the short-term and long-term efficacy.