尿碘与甲状腺结节相关性及其恶性风险的研究

Study on the correlation between urinary iodine and thyroid nodules and its malignant risk

摘要:

目的： 探究甲状腺结节与尿碘的相关性及其危险因素。方法： 选取2014年1月至2021年12月于云南省第一人民医院内分泌科进行甲状腺结节穿刺和参与“甲状腺疾病和碘营养状况的全国调查——2014”课题流调的人群为研究对象，经彩色多普勒超声检查及细胞病理学检查证实的甲状腺结节患者分为甲状腺良性结节组与甲状腺恶性结节组，合计3 206例。测定患者尿碘值、促甲状腺激素（thyroid stimulating hormone，TSH）、游离三碘甲状腺原氨酸（free triiodothyronine，FT3）、游离甲状素（free thyroxine，FT4）、甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）、甲状腺球蛋白抗体（thyroglobulin antibody，TGAb）、血生化等相关指标。采用SPSS 26.0软件进行t检验、秩和检验，危险因素采用多因素logistic回归分析。结果： ①甲状腺结节组尿碘含量（159.86 μg/L）低于健康人群（187.15 μg/L），差异有统计学意义。甲状腺结节组尿碘<100 μg/L的占比高于尿碘>300 μg/L者，甲状腺结节组碘含量构成比与健康人群比较，差异均有统计学意义（P<0.01）。②甲状腺良性结节组尿碘水平中位数（134.70 μg/L）低于甲状腺恶性结节组尿碘水平中位数（172.83 μg/L）。③Logistic回归分析结果：性别当男性赋值为1，女性赋值为2时（OR=34.400，95%CI=1.619~730.759，P=0.023），女性患甲状腺恶性结节的风险大约增加33.4倍，尿碘（OR=1.018，95%CI=1.000~1.036，P=0.048）、FT4（OR=1.876，95%CI=1.081~3.254，P=0.025）、TPOAb（OR=0.948，95%CI=0.911~0.986，P=0.008）、甘油三酯（OR=2.523，95%CI=1.194~5.330，P=0.015）是甲状腺恶性结节发生的促进因素。结论： 尿碘、性别、FT4、TPOAb、甘油三酯与甲状腺恶性结节患病有关，促进甲状腺恶性结节发生。健康人群组碘含量分布与甲状腺结节组具有统计学差异。

Abstract:

Objective: To explore the correlation between thyroid nodules and urinary iodine and its risk factors. Methods: From January 2014 to December 2021, people who had thyroid nodules puncture in the Department of Endocrinology, The First People's Hospital of Yunnan Province, and participated in the "National Survey of Thyroid Diseases and Iodine Nutrition Status–2014" were selected as the research object. The patients with thyroid nodules confirmed by color Doppler ultrasound and cytopathology were divided into the benign thyroid nodule group and the malignant thyroid nodule group with a total of 3 206 cases. Urinary iodine value, thyroid stimulating hormone (TSH) , free triiodothyronine (FT3) , free thyroxine (FT4) , thyroid peroxidase antibody (TPOAb) , thyroglobulin antibody (TGAb) , blood biochemistry, and other related indicators were measured. SPSS 26.0 was used for t-test and rank sum test. Multivariate logistic regression analysis was used to analyze the risk factors. Results: ①The urinary iodine content (159.86 μg/L) in the thyroid nodule group was lower than that in the normal population (187.15 μg/L) , and the difference was statistically significant. The proportion of urinary iodine<100 μg/L was higher than that of urinary iodine>300 μg/L in the thyroid nodule group, and the composition ratio of iodine content in the thyroid nodule group was statistically different from that in the normal population (P<0.01) .②The median urinary iodine level in the benign thyroid nodule group (134.70 μg/L) was lower than that in the malignant thyroid nodule group (172.83 μg/L) .③According to the results of logistic regression analysis, as for gender, when the male assignment was 1 and the female assignment was 2 (OR=34.400, 95%CI=1.619-730.759, P=0.023) , the results showed that the risk of malignant thyroid nodules in women was 33.4 times higher than that in men. Urinary iodine (OR=1.018, 95%CI=1.000-1.036, P=0.048) , FT4 (OR=1.876, 95%CI=1.081-3.254, P=0.025) , TPOAb (OR=0.948, 95%CI=0.911-0.986, P=0.008) , triglyceride (OR=2.523, 95%CI=1.194-5.330, P=0.015) were the promoting factors for the occurrence of malignant thyroid nodules. Conclusion: Urinary iodine, gender, FT4, TPOAb, and triglyceride are related to the prevalence of malignant thyroid nodules and promote the occurrence of malignant thyroid nodules. The distribution of iodine content in the normal group was significantly different from that in the thyroid nodule group.