何豪杰 吴秀清

[摘要] 目的 探討良恶性超声诊断弥漫型桥本氏甲状腺炎合并结节的临床应用价值。方法 方便选取该院2015年9月—2017年9月期间诊治的48例弥漫型桥本氏甲状腺炎合并结节患者作为研究对象，所有患者均行良恶性超声诊断，将诊断结果与手术病理结果进行对比，评价良恶性超声诊断的临床应用价值。 结果 超声诊断出良性病变20例，占比41.7%；恶性病变28例，占比58.3%；恶性病变患者明显多于良性病变患者，对比差异有统计学意义（P<0.05）；对比手术病理结果，超声诊断甲状腺恶性结节的准确性、敏感性、特异性分别为80.7%、84.7%、76.0%。超声各模式观察指标在甲状腺恶性结节诊断中的准确性、敏感性、特异性均在60.0%以上。腺瘤、结节性甲状腺肿的结节长径、宽径均较大，对比恶性淋巴瘤、乳头状癌，差异有统计学意义（P<0.05）；结节性甲状腺肿最大，对比恶性淋巴瘤、乳头状癌、腺瘤，差异有统计学意义（P<0.05）。结论 良恶性超声在弥漫型桥本氏甲状腺炎合并结节的临床诊断中可发挥较高的应用价值，具有操作简便、安全可靠、准确度高等优势，值得推行。

[关键词] 超声诊断；弥漫型桥本氏甲状腺炎；结节；临床

[中图分类号] R445 [文献标识码] A [文章编号] 1674-0742（2018）02（a）-0190-03

Clinical Study of Benign and Malignant Ultrasonic Diagnosis of Diffuse Hashimotos Thyroiditis Complicated with Nodules

HE Hao-jie1， WU Xiu-qing2

1.Department of Ultrasound， Qingliu County General Hospital， Sanming， Fujian Province， 365300 China； 2.Department of Obstetrics and Gynecology， Qingliu County Maternal and Child Health Hospital， Sanming， Fujian Province， 365300 China

[Abstract] Objective This paper tries to investigate the clinical value of benign and malignant ultrasonic diagnosis of diffuse Hashimoto's thyroiditis complicated with nodules. Methods 48 cases of diffuse nodules with Hashimoto's thyroiditis patients in this hospital from September 2015 to September 2017 during the diagnosis and treatment were convenient selected as the research object， all the patients underwent ultrasound diagnosis of benign and malignant， the diagnosis results were compared with the pathological results， evaluation of ultrasound diagnosis of benign and malignant clinical value. Results The ultrasound diagnosis of 20 cases of benign lesions， accounting for 41.7%； 28 cases of malignant lesions， accounting for 58.3%； the patients with malignant lesions were significantly more than patients with benign lesions， the difference was statistically significant（P<0.05）； compared with surgical and pathological results， the accuracy of ultrasound in diagnosis of thyroid malignant nodules， the sensitivity and specificity were 80.7%， 84.7%， 76.0%. The accuracy， sensitivity and specificity of each observation index of ultrasound in the diagnosis of thyroid malignant nodules were above 60.0%. Adenoma， nodular goiter nodules long diameter and wide diameter were larger， compared to malignant lymphoma， papillary carcinoma， the difference was statistically significant（P<0.05）； nodular goiter， comparison of malignant lymphoma， papillary carcinoma， adenoma， the difference was statistically significant（P<0.05）. Conclusion Benign and malignant ultrasound in diffuse Hashimotos thyroiditis combined with nodules in clinical diagnosis can play a higher application value， has the advantages of simple operation， safe and reliable， high accuracy， it is worth promoting.

[Key words] Ultrasonic diagnosis； Diffuse Hashimotos thyroiditis； Nodules； Clinical

桥本氏甲状腺炎（hashimoto s thyroiditis，HT）属于自身免疫性甲状腺疾病，临床上将其分为弥漫型、结节型、局限型以及弥漫结节型4种[1]。漫型桥本氏甲状腺炎合并结节的初期症状较不明显，随着病情的进一步发展，常出现甲状腺肿大、功能亢进、功能减退等症状，临床特征以淋巴细胞浸润为主[2]。疾病的不同时期，超声表现也有所差异，导致该病的临床诊断存在较大的难度[3]。该研究为了进一步探讨良恶性超声诊断弥漫型桥本氏甲状腺炎合并结节的临床应用价值，方便选取该院2015年9月—2017年9月期间诊治的48例患者的临床资料展开回顾性研究，现报道如下。

1 资料与方法

1.1 一般资料

方便选取该院诊治的48例弥漫型桥本氏甲状腺炎合并结节患者作为研究对象，所有患者的临床资料均完整有效，均经手术病理结果证实。患者中，男4例，女44例；年龄22～76岁，平均（45.3±10.6）岁；其中，恶性淋巴瘤1例，髓样癌1例，乳头状癌18例，滤泡性癌6例，未分化癌2例，腺瘤4例，结节性甲状腺肿14例，炎性结节2例。……