【摘要】 目的 探讨甲状腺结节患者糖脂代谢水平与甲状腺乳头状癌(PTC)发生风险的关联性。方法 回顾性分析2019年12月至2023年12月平顶山市第一人民医院收治的313例甲状腺结节患者的临床资料，根据术后病理结果将31例PTC患者纳入PTC组，282例良性结节患者纳入无PTC组。比较两组患者的一般资料和糖脂代谢指标；采用Logistic回归模型分析甲状腺结节患者发生PTC的影响因素；绘制受试者工作特征(ROC)曲线分析糖脂代谢指标对甲状腺结节患者发生PTC的预测价值。结果 PTC组患者的空腹血糖(FPG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B100 (Apo B100)水平分别为(5.74±0.96) mmol/L、(4.85±1.02) mmol/L、(2.84±0.46) mmol/L、(1.06±0.37) mmol/L，明显高于无PTC组的(5.33±0.89) mmol/L、(4.21±1.03) mmol/L、(2.23±0.51) mmol/L、(0.95±0.28) mmol/L，而高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1 (ApoA1)水平分别为(1.06±0.39) mmol/L、(1.29±0.38) mmol/L，明显低于无PTC组的(1.23±0.41) mmol/L、(1.77±0.51) mmol/L，差异均有统计学意义(P<0.05)；与无PTC组比较，PTC组患者的年龄较大、结节直径增大，高脂血症、糖尿病、甲状腺影像报告与数据系统(TI-RADS)分级≥4级构成比及促甲状腺激素(TSH)水平明显升高，差异均有统计学意义(P<0.05);Logistic回归模型分析结果显示，TSH、TI-RADS分级、FPG、LDL-C、Apo A1均是甲状腺结节患者发生PTC的影响因素(P<0.05)；经ROC分析结果显示，FPG、LDL-C、Apo A1联合预测甲状腺结节患者发生PTC的灵敏度及曲线下面积(AUC)均高于单独预测，特异度基本一致。结论 FPG、LDL-C、Apo A1是甲状腺结节患者发生PTC的影响因素，三者联合检测可预测PTC的发生。更多还原

【Abstract】 Objective To analyze the association between glucose and lipid metabolism levels and the risk of papillary thyroid carcinoma(PTC) in patients with thyroid nodules. Methods A retrospective analysis of the clinical data of 313 patients with thyroid nodules admitted to the First People’s Hospital of Pingdingshan City from December 2019to December 2023 was conducted. According to the postoperative pathological results, PTC patients were included in the PTC group(31 cases) and benign nodules patients were included in the non-PTC group(282 cases). The glucose and lipid metabolism indicators of the PTC group and the non-PTC group were compared. Logistic regression model was used to analyze the influencing factors of PTC occurrence in patients with thyroid nodules. The predictive value of glucose and lipid metabolism indicators for PTC occurrence in patients with thyroid nodules was analyzed by receiver operating characteristic(ROC) curve. Results Fasting blood glucose(FPG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), apolipoprotein B100(ApoB100) levels in PTC group were(5.74±0.96) mmol/L,(4.85±1.02) mmol/L,(2.84 ± 0.46) mmol/L,(1.06 ± 0.37) mmol/L, significantly higher than(5.33 ± 0.89) mmol/L,(4.21 ± 1.03) mmol/L,(2.23±0.51) mmol/L,(0.95±0.28) mmol/L in the non-PTC group(P<0.05). The levels of high density lipoprotein cholesterol(HDL-C) and apolipoprotein A1(ApoA1) were(1.06±0.39) mmol/L,(1.29±0.38) mmol/L, significantly lower than(1.23±0.41) mmol/L,(1.77±0.51) mmol/L in the non-PTC group(P<0.05). Compared with those in the non-PTC group, the constituent ratios of increased age, increased nodule diameter, hyperlipidemia, diabetes, Thyroid Imaging Reporting and Data System(TI-RADS) grade≥4, and thyroid stimulating hormone(TSH) level in PTC group were significantly higher(P<0.05). Logistic regression model showed that TSH, TI-RADS grading, FPG, LDL-C, and ApoA1 were influencing factors of PTC occurrence in patients with thyroid nodules(P<0.05). ROC curve showed that the sensitivity and area under the curve(AUC) of FPG, LDL-C, and ApoA1 in combination for predicting PTC occurrence in patients with thyroid nodules were higher than those of each index alone, and the specificity was basically consistent. Conclusion FPG,LDL-C, and ApoA1 are influencing factors of PTC occurrence in patients with thyroid nodules, and the three can predict the occurrence of PTC.更多还原