糖化血红蛋白、高密度脂蛋白、促甲状腺激素对甲状腺恶性结节诊断价值分析

Diagnostic value of glycosylated hemoglobin,high-density lipoprotein and thyroid stimulating hormone for malignant thyroid nodules

目的探讨糖化血红蛋白(HbA1c)、高密度脂蛋白(HDL)、促甲状腺激素(TSH)对甲状腺恶性结节的诊断价值。方法选取自2021年3月至2022年11月泸州市人民医院收治的96例甲状腺结节患者为研究对象。根据病理结果将患者分为A组(良性结节组,n=32)、B组(低度恶性结节组,n=38)、C组(恶性结节组,n=26)。比较3组患者总胆固醇、甘油三酯、低密度脂蛋白、HDL、HbA1c、TSH水平及甲状腺影像报告和数据系统(TI-RADS)分级。采用Logistic回归分析探讨甲状腺恶性结节的独立危险因素。根据多因素回归分析结果及代码指令,绘制列线图模型。采用受试者工作特征曲线分析各指标单独及联合诊断甲状腺恶性结节的效能。结果B组、C组HDL水平低于A组,且C组低于B组,差异有统计学意义(P<0.05)。B组、C组HbA1c、TSH水平高于A组,且C组高于B组,差异有统计学意义(P<0.05)。各组TI-RADS分级比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,HDL是甲状腺恶性结节的保护因素(P<0.05),HbA1c、TSH和TI-RADS分级是甲状腺恶性结节的危险因素(P<0.05)。HDL预测甲状腺恶性结节风险概率约为3.3%,HbA1c约为5.1%,TSH约为4.8%,TI-RADS分级约为98.5%。HDL+HbA1c+TSH+TI-RADS分级联合检测的受试者工作特征曲线下面积高于HDL、HbA1c、TSH、TI-RADS分级单独诊断(P<0.05),灵敏度和特异度分别为89.5%、79.3%。结论HDL是甲状腺恶性结节的保护因素,而HbA1c、TSH和TI-RADS分级是甲状腺恶性结节的独立危险因素,HDL+HbA1c+TSH+TI-RADS分级联合检测可提高甲状腺恶性结节的诊断效能。

Objective To investigate the diagnostic value of glycosylated hemoglobin(HbAlc),high-density lipoprotein(HDL)and thyroid stimulating hormone(TSH)in malignant thyroid nodules.Methods Ninety-six patients with thyroid nodules admitted to Luzhou People's Hospital from March 2021 to November 2022 were selected as the study objects.According to the pathological results,the patients were divided into group A(benign nodule group,n=32),group B(low-grade malignant nodule group,n=38)and group C(malignant nodule group,n=26).The levels of total cholesterol,triglyceride,low-density lipoprotein,HDL,HbA1c,TSH and thyroid imaging reporting and data system(TI-RADS)grades in 3 groups were compared.Logistic regression analysis was used to investigate the independent risk factors of malignant thyroid nodules.Based on the results of multi-factor regression analysis and code instructions,a nomogram model is drawn.The efficacy of each index in the diagnosis of thyroid malignant nodules alone and in combination was investigated by using the receiver operating characteristic curve.Results The HDL level of group B and group C was lower than that of group A,and that of group C was lower than that of group B,the differences were statistically significant(P<0.05).The levels of HbAlc and TSH in group B and group C were higher than those in group A,and the levels in group C were higher than those in group B,with statistical significance(P<0.05).There was statistical significance in the classification of TI-RADS grades among all groups(P<0.05).Multivariate Logistic regression analysis showed that HDL was a protective factor for malignant thyroid nodules(P<0.05),and HbA1c,TSH and TI-RADS grades were risk factors for malignant thyroid nodules(P<0.05).The risk of malignant thyroid nodules predicted by HDL was about 3.3%,HbAlc was about 5.1%,TSH was about 4.8%,and TI-RADS classification was about 98.5%.HDL+HbA1c+TSH+TI-RADS grades combined detection of subjects under the working characteristics of the curve was higher than that of HDL,HbAlc,TSH,TI-RADS grades alone diagnosis(P<0.05),sensitivity and specificity of 89.5%and 79.3%,respectively.Conclusion HDL is a protective factor for malignant thyroid nodules,while HbAlc,TSH and TI-RADS grades are independent risk factors for malignant thyroid nodules.Combined detection of HDL+HbA1c+TSH+TI-RADS grades can improve the diagnostic efficiency of malignant thyroid nodules.