目的 探讨因甲状腺结节行手术治疗的患者血清三酰甘油(TG)水平与甲状腺乳头状癌(PTC)发生风险的相关性.方法 收集2016年1月-2020年12月在解放军总医院第一医学中心行手术治疗且血脂资料完整的3340例甲状腺结节患者的临床资料进行回顾性分析.其中男940例(28.1％),女2400例(71.9％),年龄(44.5±11.4)岁;PTC 2867例,甲状腺良性结节473例.将所有患者基于术后病理分为良性结节组和PTC组,分析两组患者的一般资料,采用logistic回归分析血清TG水平与PTC发生风险的相关性,并在年龄、性别、BMI、甲状腺自身抗体亚组中分析PTC的发生风险.结果 与良性结节组相比,PTC组血清TG水平明显升高[1.2(0.8,1.7)vs.1.1(0.8,1.5),P<0.001].Logistic回归分析发现,血清TG水平与PTC发生风险升高有关(调整后OR=3.067,95％CI 1.839～5.116,P<0.001);将所有患者按血清TG水平四分位数进行分组,与最低四分位数组相比,最高四分位数组的PTC发生风险升高(调整后OR=2.142,95％CI 1.548～2.965,P<0.001);即使血清TG水平处于正常参考值范围时该相关性仍然存在(调整后OR=3.244,95％CI 1.440～7.707,P=0.005).按性别、年龄、BMI、甲状腺自身抗体进行亚组分析发现,仅在甲状腺自身抗体阴性、BMI<28 kg/m2的患者中,血清TG水平与PTC发生风险升高有关(P<0.05);此外,与≥45岁的患者相比,<45岁的患者PTC发生风险更高(P交互=0.043).结论 在甲状腺自身抗体阴性、BMI<28 kg/m2的甲状腺结节手术人群中,血清TG水平增高与PTC发生风险升高有关.

Objective To explore the association between smoking and papillary thyroid cancer （PTC） in patients who underwent thyroidectomy for thyroid nodules. Methods Retrospectively analyze the data of 5938 patients who underwent thyroidectomy with thyroid nodules confirmed pathologically as benign nodule （n=782） or PTC （n=5156） in the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2020. Clinical data including demographic characteristics， laboratory tests such as thyroid stimulating hormone（TSH） levels， thyroglobulin antibody （TgAb） and thyroid peroxidase antibody （TPOAb）， and pathological features were analyzed in different pathological type groups or smoking status groups. The association between smoking and PTC in total， male or female patients was evaluated by logistic regression models. Results There no significant difference in percentage of current smokers between PTC group and benign nodule group （P=0.104）. The PTC group had a significantly lower proportion of current smokers than the benign nodule group for males （P＜0.05） rather than for females （P＞0.05）. For all patients， current smokers had a lower prevalence of PTC than non-smokers （OR=0.735， 95%CI 0.564-0.959） after adjustment for confounders. In the gender subgroup analysis， a lower risk of PTC was found in current smokers than in non-smokers among men （OR=0.635， 95% CI 0.449-0.896）， while no association was observed among women （OR=0.910， 95% CI: 0.417-1.986） after adjustment for confounders. Conclusion For male patients with thyroid nodules considering resection， current smoking was associated with a lower risk of PTC.

目的 探讨甲状腺结节手术人群中高密度脂蛋白胆固醇(HDL-C)水平与甲状腺癌发生风险的相关性.方法 收集2016年1月-2020年12月在解放军总医院第一医学中心行甲状腺手术的3996例患者的临床资料进行回顾性分析,其中女2846例(71.2％),男1150例(28.8％),甲状腺癌3414例(85.4％),良性结节582例(14.6％).按HDL-C水平从低到高等分为五分位数组(Q1-Q5),比较5组患者的临床特征,采用多因素logistic回归分析HDL-C水平与甲状腺癌风险的相关性,建立限制性立方样条logistic回归模型分析其剂量-反应关系.结果 与最低HDL-C五分位数(Q1)的研究人群相比,随着HDL-C水平升高(Q2-Q5),女性的构成比逐渐增高,甲状腺癌的构成比、体重指数(BMI)、三酰甘油水平、空腹血糖水平逐渐降低,差异有统计学意义(P<0.05).多因素logistic回归分析显示,调整年龄、性别、BMI、促甲状腺素(TSH)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)、游离三碘甲状腺原氨酸/游离甲状腺素(FT3/FT4)等相关混杂因素后,HDL-C水平仍是甲状腺癌的独立危险因素(OR=0.52,95％CI 0.37～0.72,P<0.001),且HDL-C从低到高五分位数组趋势性检验差异有统计学意义(P趋势<0.001),敏感性分析显示E值=2.119;亚组分析显示,TgAb和TPOAb均阴性(OR=0.41,95％CI 0.28～0.60,P<0.001)的研究人群与任一抗体阳性(OR=1.12,95％CI 0.51～2.46,P=0.777)的研究人群相比,前者HDL-C与甲状腺癌风险的相关性更明显(P交互=0.014).限制性立方样条模型分析显示,男性或女性的HDL-C水平与甲状腺癌风险均不存在非线性关系.结论 因甲状腺结节行手术的人群中,高HDL-C水平与甲状腺癌风险降低相关,在TgAb及TPOAb均阴性的患者中该相关性更明显.

Objective To investigate the risk factors of lymph node metastasis in papillary thyroid carcinoma （PTC） patients who had thyroid nodule operation. Methods The retrospective study collected the clinical data of 4742 patients who had surgical treatment for thyroid nodule from January 2016 to December 2020 in our hospital. Pathologic specimens of thyroid and lymph nodes were retained in all patients during surgery. The differences of age， sex， body mass index， thyroid stimulating hormone （TSH） value， maximum tumor diameter， capsule invasion， and glandular lobe involvement were analyzed between the metastatic group and the non-metastatic group. The independent risk factors for lymph node metastasis of papillary thyroid carcinoma were evaluated by logistic regression. Results In 4742 patients with PTC， the incidence of cervical lymph node metastasis was 50.7%. Multivariate analysis showed that male， age ＜45 years， increased tumor diameter， external thyroid invasion， and multiple tumors were independent risk factors for cervical lymph node metastasis （P＜0.001）. BMI （P=0.369）， TSH level （P=0.246） and Hashimoto’s thyroiditis were not associated risk factors. Subgroup analysis showed that unilateral multiple foci was an independent risk factor for lymph node metastasis in non-microcarcinomas （OR=1.67， 95%CI 1.2-2.31， P=0.002）， and external thyroid invasion （ETE） in microcarcinomas was also a risk factor for lymph node metastasis （OR=1.58， 95%CI （1.27～1.96）， P＜0.001）. Conclusion Male， ＜45 years old， tumor size ≥9.5 mm， external thyroid invasion and multiple tumors are independent risk factors for cervical lymph node metastasis.

目的 探讨超声检查与组织病理学检查诊断桥本甲状腺炎的一致性.方法 收集2016年1月-2020年12月在解放军总医院第一医学中心因甲状腺结节行手术治疗的6238例患者的临床资料进行回顾性分析,所有患者术前甲状腺功能及超声检查资料完整,术后病理诊断明确.分析超声影像诊断桥本甲状腺炎的效能,并通过Cohen的Kappa系数(κ)评估超声与病理诊断的一致性.根据术前促甲状腺激素(TSH)水平将患者分为TSH升高组(n=329)、TSH正常组(n=5662)及TSH降低组(n=247),探讨在术前不同甲状腺功能状态下超声检查的诊断效能,以及与病理学诊断的一致性.结果(1)6238例患者中,术前超声检查提示桥本甲状腺炎1549例,术后病理诊断桥本甲状腺炎1182例;超声及病理学诊断均阳性的患者仅687例(58.1％).确诊患者中女性占88.7％(1048/1182),男性占11.3％(134/1182);女性中3种典型超声表现[实质回声减低(17.9％vs.11.8％)、网格样改变(7.5％vs.4.7％)、血流增加(14.5％vs.8.3％),P<0.001]以及超声诊断阳性率(27.8％vs.17.1％,P<0.001)、病理诊断阳性率(23.3％vs.7.7％,P<0.001)均明显高于男性.(2)一致性分析提示,超声诊断与病理诊断的一致性为一般(κ=0.367).超声诊断的敏感度为58.1％,特异度为83.0％,阳性预测值为44.4％,阴性预测值为89.4％,准确度为78.2％,其中,单一超声特征(实质回声减低、网格样改变、血流增加)在诊断时的敏感度分别为33.2％、22.0％、28.8％,特异度分别为87.8％、96.9％、91.0％,阳性预测值分别为38.8％、62.4％、42.7％,阴性预测值分别为84.9％、84.2％、84.5％,准确度分别为77.4％、82.7％、79.2％.受试者工作特征(ROC)曲线分析提示,单一超声特征或两种超声特征相结合在诊断时的预测性均较差,其中,实质回声减低及实质回声减低结合网格样改变在诊断时的表现稍好.(3)术前TSH升高组、TSH降低组的超声及病理诊断阳性率较高(TSH升高组分别为57.9％、52.2％,TSH降低组分别为33.7％、15.5％),而TSH正常组则偏低(分别为22.9％、17.7％).此外,TSH升高组中超声与病理诊断的一致性相对最好,接近中等程度(κ=0.399).结论 超声诊断及单一影像学特征在诊断桥本甲状腺炎时的特异度良好而敏感度欠佳.超声诊断与病理诊断的一致性程度一般,联合术前TSH升高时二者的一致性稍增强,但仅可作为参考.女性患者出现甲状腺功能异常时,联合超声诊断的价值更高.超声检查是桥本甲状腺炎的一项方便、快捷的支持性诊断方法.

PurposePatients with primary aldosteronism (PA) tend to exhibit a high prevalence of osteoporosis (OP) that may vary by whether PA is unilateral or bilateral, and responsive to PA treatment. To explore relationships between bone metabolism, PA subtypes, and treatment outcomes, we performed a systematic review and meta-analysis.MethodsThe PubMed, Embase, and Cochrane databases were searched for clinical studies related to PA and bone metabolism markers. Articles that met the criteria were screened and included in the systematic review; the data were extracted after evaluating their quality. R software (ver. 2022-02-16, Intel Mac OS X 11.6.4) was used for the meta-analysis.ResultsA total of 28 articles were subjected to systematic review, of which 18 were included in the meta-analysis. We found that PA patients evidenced a lower serum calcium level (mean difference [MD] = –0.06 mmol/L, 95% confidence interval [CI]: −0.10 ~ −0.01), a higher urine calcium level (MD = 1.29 mmol/24 h, 95% CI: 0.81 ~ 1.78), and a higher serum parathyroid hormone (PTH) level (MD = 2.16 pmol/L, 95% CI: 1.57 ~ 2.75) than did essential hypertension (EH) subjects. After medical treatment or adrenal surgery, PA patients exhibited a markedly increased serum calcium level (MD = –0.08 mmol/L, 95% CI: –0.11 ~ –0.05), a decreased urine calcium level (MD = 1.72 mmol/24 h, 95% CI: 1.00 ~ 2.44), a decreased serum PTH level (MD = 2.67 pmol/L, 95% CI: 1.73 ~ 3.62), and an increased serum 25-hydroxyvitamin D (25-OHD) level (MD = –6.32 nmol/L, 95% CI: –11.94 ~ –0.70). The meta-analysis showed that the ser um PTH level of unilateral PA patients was significantly higher than that of bilateral PA patients (MD = 0.93 pmol/L, 95% CI: 0.36 ~ 1.49) and the serum 25-OHD lower than that of bilateral PA patients (MD = –4.68 nmol/L, 95% CI: –7.58 ~ 1.77). There were, however, no significant differences between PA and EH patients of 25-OHD, or BMD of femoral neck and lumbar spine. BMDs of the femoral neck or lumbar spine did not change significantly after treatment. The meta-analytical results were confirmed via sensitivity and subgroup analyses.ConclusionExcess aldosterone was associated with decreased serum calcium, elevated urinary calcium, and elevated PTH levels; these effects may be enhanced by low serum 25-OHD levels. The risks of OP and fracture might be elevated in PA patients, especially unilateral PA patients, but could be reduced after medical treatment or adrenal surgery. In view, however, of the lack of BMD changes, such hypothesis needs to be tested in further studies.

Objective Fetal macrosomia is defined as a birth weight more than 4,000 g and is associated with maternal and fetal complications. This early metabolic disease may influence the entire life of the infant. Currently, macrosomia is predicted by using the estimated fetal weight (EFW). However, the EFW is inaccurate when the gestational week is gradually increasing. To assess precisely the risk of macrosomia, we developed a new predictive model to estimate the risk of macrosomia. Methods We continuously collected data on 655 subjects who attended regular antenatal visits and delivered at the Second Hospital of Hebei Medical University (Shijiazhuang, China) from November 2020 to September 2021. A total of 17 maternal features and 2 fetal ultrasonographic features were included at late-term pregnancy. The 655 subjects were divided into a model training set and an internal validation set. Then, 450 pregnant women were recruited from Handan Central Hospital (Handan, China) from November 2021 to March 2022 as the external validation set. The least absolute shrinkage and selection operator method was used to select the most appropriate predictive features and optimize them via 10-fold cross-validation. The multivariate logistical regressions were used to build the predictive model. Receiver operating characteristic (ROC) curves, C-indices, and calibration plots were obtained to assess model discrimination and accuracy. The model’s clinical utility was evaluated via decision curve analysis (DCA). Results Four predictors were finally included to develop this new model: prepregnancy obesity (prepregnancy body mass index ≥ 30 kg/m2), hypertriglyceridemia, gestational diabetes mellitus, and fetal abdominal circumference. This model afforded moderate predictive power [area under the ROC curve 0.788 (95% confidence interval [CI] 0.736, 0.840) for the training set, 0.819 (95% CI 0.744,0.894) for the internal validation set, and 0.773 (95% CI 0.713,0.833) for the external validation set]. On DCA, the model evidenced a good fit with, and positive net benefits for, both the internal and external validation sets. Conclusions We developed a predictive model for macrosomia and performed external validation in other regions to further prove the discrimination and accuracy of this predictive model. This novel model will aid clinicians in easily identifying those at high risk of macrosomia and assist obstetricians to plan accordingly.

Magnesium is considered to play a role in preventing cancer. However, the association between serum magnesium and papillary thyroid cancer (PTC) remains unknown. We retrospectively reviewed records of all patients who underwent thyroidectomy with thyroid nodules confirmed pathologically as benign nodule or PTC at our institution from January 2016 to December 2020. Data including demographic characteristics, laboratory tests, and pathological features were analyzed in 5709 adult patients eventually. The subjects with benign nodules had a higher mean serum magnesium level than those with PTC ( P < 0.001), and the proportions of PTCs decreased across quartiles of serum magnesium within the normal range. After adjustment for confounders, patients with the lowest quartile of serum magnesium had a higher prevalence of PTC than those with the highest quartile (OR = 1.421, 95%CI: 1.125–1.795, P for trend = 0.005), and the risk of PTC was 0.863 (95%CI: 0.795–0.936) for a per-SD change in serum magnesium. The contribution of serum magnesium remained in subgroup analysis ( P for interaction for all analyses > 0.05). Based on the ROC curve, the cut-off value of serum magnesium used to differentiate benign nodules from PTCs was 935 μmol/L. Combining serum magnesium with other clinical indicators can improve the efficacy of predicting PTC. Our results showed that lower serum magnesium within the normal range was associated with a greater risk of PTC among patients with thyroid nodules considering thyroidectomy. Serum magnesium may be an independent protective factor against PTC and provide additional information on the odds of malignancy in uncertain thyroid nodules in combination with other clinical factors.

<正>8胰腺疾病的超声检查8.1正常胰腺超声图像胰腺长轴切面为内部回声均质的带状或纺锤形结构,边界整齐、前表面清晰光滑。胰头稍膨大呈椭圆形,钩突呈锄头形,向左延伸分别为胰颈部、体部及尾部。胰腺为中等偏强回声,多数比肝脏回声稍强,中部可见主胰管,正常内

<正>6胆系疾病的超声检查6.1正常胆系超声图像胆囊充盈时,纵切面呈梨形,亦可见圆形或长条形,个体差异较大。正常胆囊轮廓清晰,囊壁呈光滑强回声带,胆囊腔内呈无回声,后壁线明亮,后方回声增强,显示为典型的囊性结构。正常胆囊的超声测量长径<9cm,前后径<3cm,胆囊壁<0.3cm。左右肝管可显示,位于门静脉左右支前壁,内径多<0.2cm,肝外胆管上段易于显示,纵断面位于门静脉前壁,与门静脉平行,形成

<正>7脾脏疾病的超声检查7.1正常脾脏超声图像正常脾脏表面光滑整齐,轮廓清晰,脾被膜为高回声线,脾实质呈中低回声,分布均匀。外侧缘呈弧形,内侧缘中部向内凹陷为脾门。脾门有数条管状无回声通过,为脾静脉、脾动脉。超声测值正常脾脏长径8~12cm,厚径3~

<正>5肝脏疾病的超声检查5.1正常肝脏超声图像肝脏(胆、脾、胰、肾脏)常用探头频率3.5~5MHz,正常声像图被膜呈细线状回声,光滑、整齐,轮廓清晰。膈面呈弧形,回声较强。脏面较平坦,边缘锐利。肝实质回声呈分布均匀的中低细小光点,有时可见稀疏、散在的略强光点

1概述 X线是一种波长很短的电磁波,具有穿透性,能穿透可见光不能穿透的物体.自从1895年德国物理学家伦琴发现X线后不久,X线就被用于对人体进行检查,作疾病诊断,形成了最初的放射诊断学.

<正>4甲状腺疾病的超声检查4.1甲状腺正常超声图像甲状腺位置表浅,故采用7.5~14MHz高频探头,在颈前甲状腺区横切扫查,由浅至深层,首先观察到颈前皮肤,呈增强弧形回声带;其次为皮下浅筋膜,包括脂肪及颈前浅层肌肉,为低回声。距皮肤1cm可见呈蝴蝶形或马蹄形

<正>4 CT检查4.1 CT检查类型CT是用X线束对人体检查部位一定厚度的层面进行断面扫描,借助计算机进行数字化处理而成像。CT检查分为CT平扫、CT增强扫描、CT造影等。4.1.1 CT平扫又称为普通扫描或非增强扫描,指不用对比剂增强或造影的扫描。

<正>1概述1.1基本原理超声诊断仪发射超声波进入人体后,将在组织中传播。当超声波通过各种不同脏器组织时,会产生不同振幅的反射、散射等回波或回声,对这些回声信号进行处理,可获得不同脏器组织的超声影像,即声像图。每种组织的回声强弱取决

目的 从解剖学角度阐明急性异位阑尾炎的特殊临床表现,总结出某些特殊规律性,以期提高异位阑尾炎术前的诊断准确性.方法 回顾性总结1988年至2008年收治的78例异位阑尾炎的诊治资料,结合有关文献进行综合分析.结果 78例异位阑尾炎术前有69例可明确诊断为阑尾炎,12例误诊为其他疾病,但考虑异位者仅36例.结论 急性异位阑尾炎的疾病演变过程既遵循一般急性阑尾炎的常见临床特点,同时,因为解剖位置的异常,又表现出某些特有的症状和体征,值得临床医师重视.

蛇虫咬伤并不少见,尤其在夏秋季节.最多见的有蛇、蝎子、黄蜂、蜈蚣.这些蛇虫都含毒,咬后处理不当,可致人死亡.

1 涎腺肿大 1.1 腮腺区肿物腮腺部位除炎症、肿瘤外,在临床上经常遇到腮腺和腮腺区肿大,在体表肿瘤的鉴别中,应当注意. 1.1.1 单纯性腮腺肿大单纯性腮腺肿大,亦称腮腺肥大症,临床并不少见,是一种无全身性症状和疾病的良性腮腺肿大.

1 皮下结节 皮下结节指皮下非肿瘤性的肿瘤样硬结,是某些病变及皮下增生性反应,如结节性红斑、硬结性红斑、风湿结节、药物注射硬结、皮下囊虫病等.