【摘要】：背景 甲狀腺結(jié)節(jié)（Thyroid Nodular, TN）是甲狀腺局部腺體在硬度、結(jié)構(gòu)發(fā)生異常改變的組織。在內(nèi)分泌系統(tǒng)中,甲狀腺結(jié)節(jié)是一種多發(fā)病和常見病。通過體格檢查甲狀腺觸診可獲得甲狀腺結(jié)節(jié)患病率為3%~7%。通過高清晰度B超檢查其患病率為19%~67%。通過尸檢甲狀腺結(jié)節(jié)發(fā)現(xiàn)率高達50%以上。甲狀腺結(jié)節(jié)多數(shù)為良性病變，因此絕大多數(shù)甲狀腺結(jié)節(jié)只需定期復(fù)查，可減少不必要的甲狀腺手術(shù)和手術(shù)帶來的并發(fā)癥。而甲狀腺癌則應(yīng)盡快治療，最大程度改善其預(yù)后。因此甲狀腺結(jié)節(jié)良、惡性鑒別是診斷的首要問題。以便盡早地發(fā)現(xiàn)甲狀腺癌并及時給予相應(yīng)治療。隨著診斷技術(shù)的發(fā)展，先進診斷工具的應(yīng)用，如18F-FDGPET、三維超聲、PET成像、基因檢測等，提供了甲狀腺結(jié)節(jié)鑒別診斷的新方法。在診斷甲狀腺結(jié)節(jié)過程中，超聲檢查因其無創(chuàng)傷、方便快捷、無放射性、費用低廉等特點，大大提高了患者的依從性，目前仍是首選方法。 目的 通過分析甲狀腺結(jié)節(jié)患者的超聲檢查結(jié)果、病理檢查結(jié)果。從而探討超聲檢查對甲狀腺結(jié)節(jié)鑒別診斷的臨床價值。 對象與方法 收集2010年1月至2013年1月之間在鄭州大學(xué)第二附屬醫(yī)院普外科因甲狀腺結(jié)節(jié)接受手術(shù)治療的628例患者的臨床資料、超聲檢查結(jié)果、術(shù)后病理檢查結(jié)果，進行回顧性分析。年齡分布為14～85歲，平均48.05±13.50歲，男性129例，女性499例，男：女為0.26:1�；颊咝g(shù)前均接受高分辨率超聲檢查、彩色多普勒超聲檢查和甲狀腺實時組織彈性成像檢查。收集超聲結(jié)果中甲狀腺結(jié)節(jié)的數(shù)目、回聲、周界是否清楚、邊緣是否規(guī)則、包膜是否完整、結(jié)節(jié)周圍有無聲暈、結(jié)節(jié)內(nèi)部有無鈣化、結(jié)節(jié)血流情況及彈性評分。根據(jù)術(shù)后病理檢查結(jié)果，建立二分類Logistic模型。應(yīng)用SPSS13.0軟件分析鑒別診斷甲狀腺結(jié)節(jié)的超聲征象價值。 結(jié)果 選取甲狀腺結(jié)節(jié)的數(shù)目、回聲、周界是否清楚、邊緣是否規(guī)則、包膜是否完整、結(jié)節(jié)周圍有無聲暈、結(jié)節(jié)內(nèi)部有無鈣化、血流情況及彈性評分進行χ2檢驗，結(jié)果示結(jié)節(jié)的數(shù)目（P＞0.05）沒有統(tǒng)計學(xué)意義，其余超聲征象均有統(tǒng)計學(xué)意義（P＜0.05）。建立Logistic回歸模型后，篩選出彈性評分≥3分、邊緣不規(guī)則、結(jié)節(jié)內(nèi)部鈣化灶、低回聲、包膜不完整是對鑒別甲狀腺結(jié)節(jié)良、惡性有價值的超聲征象。其中彈性評分≥3分（OR=20.892，r=2.873，P=0.000）、低回聲結(jié)節(jié)（OR=12.533，r=2.296，P=0.000）、結(jié)節(jié)邊緣不規(guī)則（OR=19.494，r=2.570，P=0.000）、結(jié)節(jié)內(nèi)鈣化灶（OR=14.421， r=2.351， P=0.001）、包膜不完整（OR=3.861，r=1.351， P=0.009）作為自變量進入Logistic回歸回歸方程：Logit(P)=0.783＋1.351×包膜＋2.570×邊緣＋2.296×回聲＋2.351鈣化＋2.873×彈性評分。該回歸模型進行似然比檢驗。結(jié)果為χ2=168.112，，P=0.000（P＜0.05）。其模型有統(tǒng)計學(xué)意義。繪制ROC曲線，曲線下面積為AUZ0.812。 結(jié)論 1.甲狀腺結(jié)節(jié)的數(shù)目對鑒別甲狀腺結(jié)節(jié)良、惡性沒有價值。 2.結(jié)節(jié)周界、聲暈、周邊血流情況鑒別甲狀腺結(jié)節(jié)良、惡性價值較低。而結(jié)節(jié)彈性評分、邊緣是否規(guī)則、結(jié)節(jié)內(nèi)鈣化灶情況、回聲、結(jié)節(jié)包膜的鑒別診斷價值較大。 3.其診斷價值從大到小為彈性評分＞邊緣不規(guī)則＞結(jié)節(jié)內(nèi)鈣化灶＞低回聲＞包膜不完整。
[Abstract]:background The thyroid nodule (TN) is a group of thyroid local glands with abnormal changes in hardness and structure. In the endocrine system, thyroid nodule is a kind of multi-morbidity and common The prevalence of thyroid nodules can be found to be 3% ~ 7 by physical examination of thyroid palpation %. The prevalence of high-definition B-ultrasound is 19% ~ 67 %. The rate of discovery of thyroid nodules by necropsy was as high as 50%. The majority of the thyroid nodules are benign, so the vast majority of the thyroid nodules need to be regularly reviewed to reduce the complications associated with unnecessary thyroid surgery and surgery. The thyroid cancer should be treated as soon as possible, and its pre-treatment should be improved to the maximum extent. After that, it is the primary question of the diagnosis of benign and malignant thyroid nodules. In order to find thyroid cancer as early as possible and to give the corresponding treatment in a timely manner With the development of diagnostic technology, the application of advanced diagnostic tools, such as 18F-FDGPT, 3D ultrasound, PET imaging, gene detection and so on, provides a new prescription for the differential diagnosis of thyroid nodules. in that proces of the diagnosis of the thyroid nodule, the ultrasonic examination greatly improves the compliance of the patient because of the characteristics of no trauma, convenience and quickness, no radioactivity, low cost and the like, Law. Objective To analyze the results of ultrasonography in patients with thyroid nodules and their disease. To study the results of the examination of thyroid nodules by means of ultrasonic examination. Clinical value Methods: The clinical data, the results of the ultrasonic examination and the postoperative pathological examination were collected between January 2010 and January 2013 between January 2010 and January 2013 at the second affiliated hospital of Zhengzhou University. The age distribution ranged from 14 to 85 years, with an average of 48.05 to 13.50, a male of 129, a female of 499, and a male. : The female was 0.26:1. The patients received high-resolution ultrasound, color Doppler ultrasound and thyroid imaging before the operation. The elastic imaging of the tissue was examined. The number of thyroid nodules in the ultrasound was collected, the echo, the perimeter was clear, the edges were regular, the envelope was intact, there was a silent halo around the nodule, and there were calcifications and nodules in the nodules. Blood flow condition and elastic score. According to the results of postoperative pathological examination, a two-class L was established. Logistic model and application of SPSS13.0 software for differential diagnosis of thyroid nodule The results were as follows: the number of thyroid nodules, the echo, whether the perimeter is clear, whether the edge is regular, whether the envelope is complete, there is a silent halo around the node, and there is no calcification or blood flow inside the nodule. The results showed that the number of nodules (P> 0.05) was not of statistical significance and the other ultrasound signs were all. Statistical significance (P <0.05). After the logistic regression model was established, the score of elastic score was 3, the edge was irregular, the inside of the nodule was calcified, and the low echo and the envelope were incomplete. The score of elastic score was 3 (OR = 20.892, r = 2.873, P = 0.000), low echo nodule (OR = 12.533, r = 2.296, P = 0.000), the edge of the node was irregular (OR = 19.494, r = 2.570, P = 0.000), the calcification in the nodule (OR = 14.421, r = 2.351, P = 0.001), the envelope was incomplete (OR = 3.861, r = 1.351, P = 0.009) as the independent variable to enter L. Logistic regression equation: Logit (P) = 0.783 + 1.351 envelope + 2.570 + edge + 2.296 + echo + 2.351 Calcification + 2.873 elastic score . The regression model is used for likelihood ratio test. The result is[2 = 攏112, P = 0.000(P錛

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