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ENGLISH ABSTRACT
超声TI-RADS分级在甲状腺结节鉴别诊断中的应用价值及与患者MK、TK1、甲状腺功能指标的相关性
李国婷
董彦金
卫娜
王秀丽
作者及单位信息
·
DOI： 10.3760/cma.j.cn341190-20240719-00930
Application value of ultrasound TI-RADS classification in the differential diagnosis of thyroid nodules and its correlation with patients' midkine, thymidine kinase 1, and thyroid function indicators
Li Guoting
Dong Yanjin
Wei Na
Wang Xiuli
Authors Info & Affiliations
Li Guoting
Department of Surgery, Jinan 2nd People's Hospital, Jinan 250021, Shandong Province, China
Dong Yanjin
Department of Laboratory Medicine, Jinan 2nd People's Hospital, Jinan 250021, Shandong Province, China
Wei Na
Department of Surgery, Jinan 2nd People's Hospital, Jinan 250021, Shandong Province, China
Wang Xiuli
Department of Surgery, Jinan 2nd People's Hospital, Jinan 250021, Shandong Province, China
·
DOI： 10.3760/cma.j.cn341190-20240719-00930
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摘要

目的分析超声甲状腺影像报告和数据系统（TI-RADS）分级在甲状腺结节鉴别诊断中的应用效果及与患者血清中期因子（MK）、胸苷激酶1（TK1）、甲状腺功能指标的相关性。

方法该研究为前瞻性研究。收集2022年12月至2024年2月于济南市第二人民医院就诊的甲状腺结节患者108例（120个结节），给予超声检查，完成TI-RADS分级，检测患者血清MK、TK1水平及甲状腺功能，以患者病理结果为依据，分析TI-RADS诊断结果与病理结果的一致性，计算其诊断效能，观察TI-RADS各分级恶性结节发生情况，比较良性结节与恶性结节患者血清MK、TK1及甲状腺功能指标差异，并进行甲状腺结节患者TI-RADS分级与其血清MK、TK1及甲状腺功能指标的相关性分析。

结果经病理检查检出恶性结节38个，良性结节82个；超声TI-RADS分级诊断与病理诊断结果一致性较好（ Kappa=0.90， P < 0.001），其诊断灵敏度、特异度、准确率分别为86.84%（33/38）、97.56%（80/82）、94.17%（113/120）；超声TI-RADS分级观察中，Ⅳb及Ⅴ级甲状腺结节恶性率最高，分别为92.00%（23/25）、100.00%（10/10）；恶性结节组血清MK、TK1及促甲状腺激素（TSH）水平均显著高于良性结节组（均 P < 0.05）；相关性分析表明，TI-RADS分级与血清MK、TK1、TSH水平均呈正相关（ r=0.56、0.60、0.52，均 P < 0.05）。

结论超声TI-RADS分级可用于甲状腺结节性质鉴别，准确率高，漏诊、误诊风险低，且与患者MK、TK1、THS等指标密切相关，可为甲状腺癌的检出提供依据。

甲状腺结节;超声检查;胸苷激酶;甲状腺功能试验;促甲状腺素;病理学，临床
ABSTRACT

ObjectiveTo analyze the application value of ultrasound Thyroid Imaging Reporting and Data System (TI-RADS) classification in the differential diagnosis of thyroid nodules and its correlation with patients' midkine, thymidine kinase 1, and thyroid function indicators.

MethodsThis study was a prospective study. A total of 108 patients with thyroid nodules (120 nodules) who visited Jinan 2 nd People's Hospital from December 2022 to February 2024 were included. Ultrasound examinations were conducted to complete the TI-RADS classification, and serum levels of midkine (MK) and thymidine kinase 1 (TK1), as well as thyroid function indicators, were measured. Based on the patients' pathological results, the consistency between the TI-RADS diagnostic results and the pathological findings was analyzed. The diagnostic efficacy of TI-RADS classification was calculated. The incidence of malignant nodules across various TI-RADS categories was assessed, and the differences in serum levels of MK, TK1, and thyroid function indicators between patients with benign and malignant nodules were compared. Additionally, a correlation analysis was performed to analyze the correlation between the TI-RADS classification of thyroid nodules and the serum levels of MK, TK1, and thyroid function indicators.

ResultsPathological examination results revealed 38 malignant nodules and 82 benign nodules. The consistency between ultrasound TI-RADS classification diagnoses and pathological results was good ( Kappa = 0.90, P < 0.001), with diagnostic sensitivity, specificity, and accuracy of 86.84% (33/38), 97.56% (80/82), and 94.17% (113/120), respectively. Among the ultrasound TI-RADS classifications, the malignant rates for category Ⅳb and category Ⅴ thyroid nodules were the highest, at 92.00% (23/25) and 100.00% (10/10), respectively. Serum levels of MK, TK1, and thyroid-stimulating hormone (TSH) were significantly higher in patients with malignant thyroid nodules than in those with benign thyroid nodules (all P < 0.05). Correlation analysis indicated that TI-RADS classification was positively correlated with serum levels of MK, TK1, and TSH ( r = 0.56, 0.60, 0.52, all P < 0.05).

ConclusionsUltrasound TI-RADS classification can be used to differentiate the nature of thyroid nodules, demonstrating high accuracy with low risks of missed or misdiagnoses. It is also closely related to indicators such as MK, TK1, and TSH, providing a basis for the detection of thyroid cancer.

Thyroid nodule;Ultrasonography;Thymidine kinase;Thyroid function tests;Thyrotropin;Pathology，clinical
Wang Xiuli, Email: mocdef.qabq547157577
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引用本文

李国婷,董彦金,卫娜,等. 超声TI-RADS分级在甲状腺结节鉴别诊断中的应用价值及与患者MK、TK1、甲状腺功能指标的相关性[J]. 中国基层医药,2025,32(03)：409-413.

DOI:10.3760/cma.j.cn341190-20240719-00930

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甲状腺结节为甲状腺组织异常增生后形成，临床虽以良性结节多见，但仍有一定恶性风险。甲状腺癌较其他恶性肿瘤预后好，但及早诊断并治疗是患者获得良好预后的关键 ［ 1 ］ 。甲状腺属于浅表器官，无厚脂肪、肌肉覆盖，超声检查即可达到初步诊断的目的 ［ 2 ］ 。甲状腺影像报告和数据系统（thyroid imaging reporting and data system，TI-RADS）分级是近年甲状腺结节诊断中常用良恶性风险分级系统，TI-RADS主要根据甲状腺结节不同超声特征对其进行分期，一般分期越大受评估结节恶性风险越高 ［ 3 ］ 。既往研究表明，甲状腺结节患者较正常人血清中期因子（midkine，MK）、胸苷激酶1（thymidine kinase 1，TK1）水平明显上升，且恶性结节MK、TK1水平较良性结节更高，可用于甲状腺结节的良恶性诊断。甲状腺癌发生、发展过程中常伴有一定程度的甲状腺功能改变，监测甲状腺功能指标也可对甲状腺结节的性质进行辅助判断 ［ 4 , 5 ］ 。本研究探讨超声TI-RADS分级诊断甲状腺结节性质的效果及与患者MK、TK1、甲状腺功能指标的关系。现报告如下。
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备注信息
A
王秀丽，Email： mocdef.qabq547157577
B

李国婷：研究设计、数据收集；董彦金：数据整理、数据分析、技术支持；卫娜、王秀丽：论文起草、论文修改

C
李国婷, 董彦金, 卫娜, 等. 超声TI-RADS分级在甲状腺结节鉴别诊断中的应用价值及与患者MK、TK1、甲状腺功能指标的相关性[J]. 中国基层医药,2025,32(3):409-413. DOI:10.3760/cma.j.cn341190-20240719-00930.
D
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