适碘地区老年人甲状腺结节的患病率及危险因素调查

Prevalence and risk factors of thyroid nodules in the elderly in iodine-sufficient areas

摘要:

目的 调查江苏适碘地区农村老年人群甲状腺结节和甲状腺癌的患病率，并分析甲状腺结节患病的危险因素。方法 采用整群抽样的方法对江苏适碘地区进行横断面调查研究，选取2 590例60岁及以上的常驻居民进行体检与生化检查，采用甲状腺影像学报告及数据系统（Thyroid Imaging Reporting And Data System，TI-RADS）分类方法对甲状腺结节进行分类评估，并对部分甲状腺结节进行超声引导下活检病理检查，采用Logistic回归分析甲状腺结节的危险因素。结果 2 590例受者中共检出甲状腺结节883例，总体患病率为34.09%（883/2 590），女性患病率明显高于男性（χ²=27.885，P=0.000），有甲状腺结节组和无甲状腺结节组相比，身高、体质指数、空腹血糖、糖化血红蛋白、空腹胰岛素、甘油三酯、25羟维生素D差异有统计学意义（分别为t=5.337、P=0.000，t=-5.160、P=0.000，t=-2.341、P=0.019，t=-4.993、P=0.000，t=-2.384、P=0.020，t=-2.940、P=0.003，t=6.432，P=0.000）。男性甲状腺结节的患病率随年龄的增加而增加。老年人甲状腺癌的总体检出率为0.34%。Logistic回归分析结果显示，体质指数和糖化血红蛋白是甲状腺结节患病的危险因素（OR=1.054，95%CI=1.028~1.081，P<0.01；OR=1.257，95%CI=1.117~1.414，P<0.01）。结论 甲状腺结节是老年人常见的甲状腺疾病，但甲状腺癌的患病率总体较低。糖脂代谢紊乱与甲状腺结节的患病密切相关。

Abstract:

Objective To investigate the prevalence of thyroid nodules and thyroid cancer and the risk factors for thyroid nodules in a rural elderly population in iodine-sufficient areas of Jiangsu Province，China.Methods A cross-sectional survey was performed in iodine-sufficient areas of Jiangsu Province，investigating a total of 2 590 permanent residents aged ≥60 years selected by cluster sampling. They underwent physical examination and biochemical tests. Thyroid nodules were classified using the Thyroid Imaging Report and Data System（TI-RADS），part of which were examined for pathological information through an ultrasound-guided biopsy. A logistic regression analysis was used to analyze the risk factors for thyroid nodules.Results A total of 883 cases of thyroid nodules were detected in 2590 subjects. With an overall prevalence of 34.09%（883/2 590）. The prevalence of female subjects was significantly higher than that of male subjects（χ²=27.885，P=0.000）. There were significant differences in height（Ht），body mass index（BMI），fasting blood glucose（FBG），glycosylated hemoglobin（HbA1c），fasting insulin（FINS），triglyceride（TG），and 25-hydroxyvitamin D［25（OH）D］ between the participants with and without thyroid nodules（t=5.337、P=0.000，t=-5.160、P=0.000，t=-2.341、P=0.019，t=-4.993、P=0.000，t=-2.384、P=0.020，t=-2.940、P=0.003，t=6.432、P=0.000，respectively）. The prevalence of thyroid nodules in men increased with age. The overall detection rate of thyroid cancer in the elderly was 0.34%. The logistic regression analysis showed that the BMI and HbA1c hemoglobin were risk factors for thyroid nodules（OR=1.054，95%CI=1.028-1.081，P<0.01；OR=1.257，95%CI=1.117-1.414，P<0.01）.Conclusion Thyroid nodules are prevalent in the elderly in iodine-sufficient areas of Jiangsu Province，with a low prevalence of thyroid cancer. Glucose and lipid metabolism disorders are significantly related to the prevalence of thyroid nodules.