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目的探讨术前血清促甲状腺激素(thyroid stimulating hormone,TSH)水平与甲状腺结节良恶性的关系,以发现恶性甲状腺结节的预测因子。方法回顾性分析四川大学华西医院甲状腺外科2013年4月至2014年4月收治的甲状腺结节患者的临床资料,采用logistic回归及ROC曲线判断术前血清TSH水平对恶性甲状腺结节的预测价值。结果共纳入623例患者,最终组织病理学结果示良性结节126例(20.2%)、恶性结节497例(79.8%)。Logistic回归分析显示年龄、甲状腺球蛋白水平、术前血清TSH是恶性甲状腺结节的是独立影响因素。即使TSH水平是在正常范围之内,其水平越高,甲状腺结节的恶性风险越高:与TSH<0.27mU/L的患者相比,TSH在2.501~4.2mU/L之间的患者甲状腺结节的恶性风险增加(OR=5.842,95%CI:2.164~15.775,P=0.005 6)。对术前TSH水平行诊断效能(ROC曲线)分析,曲线下面积为0.652,与甲状腺结节良、恶性有关的切点值为1.06mU/L,特异度为75.8%,敏感度为46.1%。结论术前血清TSH水平可能是恶性甲状腺结节的预测因子。
Objective To investigate the relationship between preoperative serum thyroid stimulating hormone (TSH) levels and benign and malignant thyroid nodules in order to find out the predictor of malignant thyroid nodules. Methods The clinical data of patients with thyroid nodules from April 2013 to April 2014 in Department of Thyroid Surgery, West China Hospital of Sichuan University were retrospectively analyzed. The predictive value of preoperative serum TSH level in malignant thyroid nodules was analyzed by logistic regression and ROC curve. Results A total of 623 patients were enrolled. The final histopathological findings showed 126 benign nodules (20.2%) and 497 malignant nodules (79.8%). Logistic regression analysis showed that age, thyroglobulin level and preoperative serum TSH were independent factors of malignant thyroid nodules. The higher the level of TSH, the higher the risk of thyroid nodules, even though the level of TSH is within the normal range: the thyroid gland in patients with TSH between 2.501 and 4.2 mU / L, compared with patients with TSH <0.27 mU / L The risk of malignancy increased (OR = 5.842, 95% CI: 2.164 to 15.775, P = 0.005 6). The preoperative TSH level diagnostic performance (ROC curve) analysis, the area under the curve was 0.652, with thyroid nodules benign and malignant related cut-off value of 1.06mU / L, specificity was 75.8%, the sensitivity was 46.1%. Conclusion Preoperative serum TSH levels may be predictors of malignant thyroid nodules.