摘要
目的探讨多中心健康人群体质量指数(BMI)与甲状腺结节恶性风险分层的相关性。方法以2015年1月至2017年12月在5个体检中心进行体检并接受甲状腺超声检查的6070名体检者为研究对象,进行体格检查、生化指标及甲状腺超声检查,所有筛查人员均经过认证培训,其中课题组超声医生均参加了大型流调课题前的甲状腺结节超声风险评估培训,并考核通过。结果 6070名体检者中,5773人(95. 1%)来自华北地区,其中2833人共有4274个结节; 297人(4. 9%)来自华中地区,其中158人共有183个结节;两地区甲状腺结节的患病率无统计学意义(X^2=1. 923,P=0. 092)。2991例(49. 3%,2991/4557)有结节的患者中,1479例(49. 4%)为单发结节,1512例(50. 6%)为多发结节; 398例(13. 3%)结节> 1 cm,2593例(86. 7%)结节≤1 cm。结节组女性比例(X^2=156. 36,P=0. 000)、年龄(t=-18. 768,P=0. 000)和空腹血糖(FBG)水平(t=-3. 808,P=0. 000)均明显高于无结节组。在所有检出的4457个结节中,良性、极低风险、低风险、中等风险和高风险结节的检出率分别为4. 5%、6. 6%、85. 0%、0. 1%和3. 7%。其中,中等风险及以下结节共有4291个,高风险结节共有166个。与中等风险及以下结节患者相比,高风险结节患者低BMI比例明显较高(X^2=25. 161,P=0. 000),FBG水平明显较低(t=3. 357,P=0. 000)。多因素非条件Logistic回归结果显示,低BMI (OR=2. 900,95%CI:1. 461～5. 783,P=0. 002)和高FBG水平(OR=0. 803,95%CI:0. 675～0. 955,P=0. 013)是结节为高风险的独立危险因素。低体质量人群中高风险结节检出率明显高于正常体质量人群和超重及肥胖人群(X^2=25. 16,P=0. 000)。在≥55岁人群中,低体重人群中高风险结节的比例明显升高(X^2=44. 868,P=0. 000)。结论低体质量和年龄≥55岁与罹患高风险甲状腺结节存在关联。
Objective To investigate the relationship between body mass index(BMI)and risk levels of thyroid nodules in a multi-center healthy population.Methods A total of 6070 subjects were enrolled from five medical physical examination centers in China fromJanuary 2015 to December 2017.All the participants’generalinformation and parameters were recorded.Thyroid nodules were detected by color Doppler ultrasonography.All ultrasound doctors received uniform training before study.Results Among all the subjects,5773(95.1%;with 4274 nodules identified in 2833 subjects)were from northern China and 297(4.9%,with 183 nodules identified in 158 subjects)from central China(χ^2=1.923,P=0.092).The nodules were single in 1479 of 2991 subjects(49.4%)and multiple in 1512 subjects(50.6%).Nodules larger than 1 cm accounted for 13.3%and nodules smaller than 1 cm accounted for 86.7%.Compared with the non-thyroid nodule group,the thyroid nodule group had significantly more women(χ^2=156.36,P=0.000),older age(t=-18.768,P=0.000),and higher fasting blood glucose(FBG)level(t=-3.808,P=0.000).Among all the nodules,the prevalence rates of benign,very-low-risk,low-risk,moderate risk,and high risk were 4.5%,6.6%,85.0%,0.1%,and 3.7%,respectively,according to the ATA guidelines.Notably,there were 4291 nodules at moderate or lower risks and 166 nodules at high risk.Compared with the former,patients with high-risk nodules had significantly lower BMI(χ^2=25.161,P=0.000)and high FBG(t=3.357,P=0.000).Multivariate non-conditional Logistic regression showed low BMI(OR=2.900,95%CI:1.461-5.783,P=0.002)and high FBG level(OR=0.803,95%CI:0.675-0.955,P=0.013)were independent risk factors for high-risk nodules.Compared with subjects with normal weight or obese populations,subjects with low BMI had significantly higher detection rate of high-risk nodules(χ^2=25.16,P=0.000).In≥55 year-old group,significantly more high-risk nodules were detected in low BMI group(χ^2=44.868,P=0.000).Conclusion Low weight is associated with high-risk thyroid nodules among people�
作者
王莹
赖兴建
杨筱
邓笑伟
姜树强
杨晓巍
唐世琪
王君
马春梅
李玲
张波
WANG Ying;LAI Xingjian;YANG Xiao;DENG Xiaowei;JIANG Shuqiang;YANG Xiaowei;TANG Shiqi;WANG Jun;MA Chunmei;LI Ling;ZHANG Bo(Department of Ultrasound,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Physical Examination Center,China Armed Police General Hospital,Beijing 100039,China;Physical Examination Center,PLA Air Force General Hospital,Beijing 100142,China;Physical Examination Center,Tianjin Hospital,Tianjin 300211,China;Physical Examination Center,Hubei General Hospital,Wuhan 430060,China;Physical Examination Center,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2019年第1期93-98,共6页
Acta Academiae Medicinae Sinicae
基金
首都卫生发展科研专项基金(2016-2-40110)
北京协和医学院2016教育教学改革项目(2016zlgc0108)
中国健康促进基金会项目(2017-76)~~
