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投稿时间：2025-05-14 网络发布日期：2026-01-27
投稿时间：2025-05-14 网络发布日期：2026-01-27
中文摘要: 目的 探讨促甲状腺激素（TSH）、超声特征、超声引导下细针穿刺（US-FNA）细胞学检查及BRAFV600E<0.05基因检测在甲状腺结节良恶性鉴别诊断中的准确性和价值。方法 回顾性分析2021年1月至2024年11月在山东省立医院菏泽医院行甲状腺穿刺及手术切除的325例甲状腺结节患者的临床资料。分析判断恶性甲状腺结节发生的影响因素，根据影响因素构建logistic回归预测模型，并绘制受试者工作特征（ROC）曲线，采用ROC曲线下面积（AUC）评估TSH、超声特征、US-FNA 细胞学检查及BRAFV600E<0.05基因检测对恶性甲状腺结节发生的预测效能。结果 325例甲状腺结节患者中，有52.92%（172/325）的患者术后病理结果为恶性（恶性组），47.08%（153/325）的患者为良性（良性组）。多因素logistic回归分析结果证实，TSH、超声甲状腺结节纵横比、质地、形态、回声、钙化、边界、血流等特征和US-FNA 细胞学检查、BRAFV600E<0.05基因检测均为恶性甲状腺结节发生的独立影响因素（P<0.05）。基于上述影响因素构建logistic回归联合预测模型：logistic（P）=-6.908+0.422×TSH+0.556×纵横比+0.562×结节质地+0.583×结节形态+0.591×结节回声+0.610×结节钙化+0.585×边界+0.594×血流+0.632×US-FNA细胞学检查+0.665×BRAFV600E<0.05基因检测。ROC曲线结果显示，该模型预测恶性甲状腺结节发生的灵敏度、特异度及AUC分别为82.18%、90.67%和0.912。结论 TSH、超声特征、US-FNA细胞学及BRAFV600E<0.05基因检测均可作为判别甲状腺结节良恶性的重要方法，但四者联合多视角综合评估恶性甲状腺结节发生的灵敏度、特异度及AUC水平均较高，预测效能好，可进一步提高甄别甲状腺结节良恶性的准确性。
Abstract:Objective To explore the accuracy and value of thyroid-stimulating hormone（TSH），ultrasound features，ultrasound-guided fine-needle aspiration （US-FNA） cytology，and BRAFV600E<0.05 gene detection in the differential diagnosis of benign and malignant thyroid nodules. Methods A retrospective analysis was conducted on the clinical data of 325 patients with thyroid nodules who underwent thyroid puncture and surgical resection at Heze Hospital of Shandong Provincial Hospital from January 2021 to November 2024. The influencing factors of the occurrence of malignant thyroid nodules were analyzed，and a logistic regression prediction model was constructed based on these factors. The receiver operating characteristic（ROC）curves were plotted，and the area under the ROC curve（AUC）was used to evaluate the predictive performance of TSH，ultrasound features，US -FNA cytology，and BRAFV600E<0.05 gene detection for malignant thyroid nodules. Results Among the 325 patients with thyroid nodules，52.92%（172/325）had malignant postoperative pathological results（malignant group），while 47.08%（153/325）had benign results（benign group）. Multivariate logistic regression analysis confirmed that TSH，ultrasonic features including aspect ratio，texture，shape，echogenicity，calcification，boundary，blood flow of thyroid nodule，as well as US-FNA cytology，and BRAFV600E<0.05gene detection were all independent influencing factors for malignant thyroid nodules（P<0.05）. Based on these risk factors，a logistic regression combined prediction model was constructed：logistic（P）=- 6.908 + 0.422 × TSH +0.556 × aspect ratio + 0.562 × nodule texture + 0.583 × nodule shape + 0.591 × nodule echogenicity + 0.610 × nodule calcification + 0.585×boundary+ 0.594×blood flow+0.632×US-FNA cytology + 0.665×BRAFV600E<0.05 gene detection. ROC curve results showed that the sensitivity，specificity，and AUC of this model in predicting malignant thyroid nodules were 82.18% ，90.67% ，and 0.912，respectively. Conclusion TSH，ultrasound features，US-FNA cytology，andBRAFV600E<0.05 gene detection can all be served as important Methods for distinguishing benign and malignant thyroid nodules. However，the combined multi-perspective assessment of these four factors yields higher sensitivity，specificity，and AUC levels in predicting malignant thyroid nodules，demonstrating superior predictive performance and further improving the accuracy of differentiating benign from malignant thyroid nodules.
keywords: Thyroid nodules Ultrasound features Thyroid-stimulating hormone Ultrasound-guided fine-needle aspiration Cytology BRAFV600E<0.05 gene
文章编号： 中图分类号：R581 文献标志码：A
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附件
| Author Name | Affiliation |
| TIAN Hongtao*，ZHU Jinbiao | *Department of Pathology,Heze Hospital of Shandong Provincial Hospital,Heze,Shandong 274000,China |
引用文本：
田洪涛,朱金彪.促甲状腺激素、超声特征、刺细胞学及BRAFV600E<0.05检测在甲状腺结节良恶性诊断中的应用[J].中国临床研究,2026,39(1):93-97,102.
田洪涛,朱金彪.促甲状腺激素、超声特征、刺细胞学及BRAFV600E<0.05检测在甲状腺结节良恶性诊断中的应用[J].中国临床研究,2026,39(1):93-97,102.