王文超 杨丽 张春霞

[摘要] 目的 探讨与甲状腺结节良、恶性鉴别相关的临床因素。 方法 回顾性分析2009年1月～2014年10月北京市顺义区医院收治的426例甲状腺结节患者的临床资料。 结果 本组资料中，良性病变382例（89.67%），恶性病变44例（10.33%）；单因素分析结果：患者为男性、年龄≤20岁、位于右叶的病灶及伴钙化的甲状腺结节恶性可能性大（P<0.05），TSH水平对甲状腺结节性质的鉴别无统计学意义（P>0.05）；多因素分析结果：患者为男性、年龄≤20岁、位于右叶的病灶及伴钙化者患甲状腺恶性肿瘤的可能性大（P<0.05）。 结论 患者性别、年龄、病灶位置及是否伴钙化对甲状腺结节病变性质的鉴别具有重要临床意义。

[关键词] 甲状腺结节；良性；恶性；钙化

[中图分类号] R736.1 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0046-03

[Abstract] Objective To investigate the relationship between the clinical factors and the character of the thyroid nodules. Methods The clinical data of 426 patients with thyroid nodules who were treated in Shunyi Hospital were retrospectively analyzed. Results In this study，382 cases （89.67%） were benign and 44 cases （10.33%） were malignant.Univariate analysis：The possibility of suffering thyroid cancer increased when the patient with thyroid nodules was male，younger than 20 years of age，the nodules located in the right lobe，or when the patient was accompanied by calcification（P<0.05）.The level of thyroid stimulating hormone was not correlated with diagnosis of benign and malignant lesions of the nodules （P>0.05）.Multivariate analysis：The patient with thyroid nodules was male，younger than 20 years of age，the nodules located in the right lobe，or when the patient was accompanied by calcification had a higher chance of suffering from thyroid cancer. Conclusion For the patient presenting with thyroid nodules，the sex and the age of patient，the locations of the thyroid nodules and the accompanying by calcification have important clinical significance in diagnosis of benign and malignant lesions of thyroid nodules.

[Key words] Thyroid Nodules；Benign；Malignant；Calcification甲状腺结节是甲状腺外科门诊日常患者就诊最常见的主诉，其发病率呈逐年上升的趋势，成人中其发病率达3%～7%，尤其以女性多见[1]。甲状腺结节以良性病变为主，但恶性病变仍占有很大比例，占甲状腺结节的5%～7%[2]。如何结合患者的临床因素提高对甲状腺结节性质判断的准确性具有重要意义。本文通过对426例甲状腺结节患者的临床资料进行回顾性分析，探讨与甲状腺结节性质鉴别相关的临床因素与诊断问题。

1 资料与方法

1.1 一般资料

收集2009年1月～2014年10月于北京市顺义区医院就诊并行手术治疗的426例甲状腺结节患者的临床资料，其中男80例，女346例，男女比例为1∶4.33，年龄18～84岁，中位年龄49.5岁。病灶位于甲状腺左叶100例，右叶139例，双侧179例，峡部8例。

1.2 辅助检查

术前均行血清促甲状腺素（thyroid stimulating hormone，TSH）水平检测及甲状腺超声检查，其中TSH低于正常水平70例，正常或高于正常水平356例；超声检查提示甲状腺单发结节175例，多发结节202例，单发甲状腺结节伴钙化者20例，多发结节伴钙化29例。……