1、myocardial infarction causes endothelial injury by targeting 7-nAchRJ.Cell Mol Med,2019,23(9):6085-6097.10Ling TY,Wang XL,Chai Q,et al.Regulation of the SK3 channel by microRNA-499-potential role in atrial fibrilla-tionJ.Heart Rhythm,2013,10(7):1001-1009.11 中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会,中国房颤中心联盟心房颤动
2、防治专家工作委员会.心房颤动:目前的认识和治疗建议(2021)J.中华心律失常学杂志,2022,26(1):15-88.12Ling TY,Wang XL,Chai Q,et al.Regulation of cardiac CACNB2 by microRNA-499:Potential role in atrial fibril-lationJ.BBA Clin,2017,2(7):78-84.13Jiang XC,Yu Y.The Role of Phospholipid transfer protein in the development of atherosclerosisJ.Cu
3、rr Atheroscler Rep,2021,23(3):9.14Zhang M,Zhai X,Li J,et al.Structural basis of the lipid transfer mechanism of phospholipid transfer protein(PLTP)J.Biochim Biophys Acta Mol Cell Biol Lipids,2018,1863(9):1082-1094.【文章编号】1006-6233(2023)08-1298-05US-FNA 与 US-CNB 在不同大小甲状腺结节诊断中的价值比较辛敏慧,张植兰,李忠举(中南大学湘雅医学院
4、附属海口医院超声医学科,海南海口 570208)【摘要】目的:比较细针穿刺活检(US-FNA)与粗针穿刺活检(US-CNB)在不同大小甲状腺结节诊断中的价值。方法:选取 2020 年 3 月至 2022 年 3 月我院收治的甲状腺结节患者 106 例,将患者根据结节最大直径进行分组,患者结节最大直径10mm 纳入 A 组,最大直径10mm 纳入 B 组,所有患者均进行 US-FNA 与 US-CNB 检查,并于术后进行病理诊断,以术后病理诊断为金标准,探究 US-FNA 与US-CNB 在不同大小甲状腺结节诊断中的价值。结果:A 组患者中恶性结节 37 例(2 例滤泡癌,28 例乳头状癌,3
5、例甲状腺淋巴瘤,4 例甲状腺肉瘤),良性结节 13 例(2 例结节性甲状腺肿伴滤泡性腺瘤结节,11 例结节性甲状腺肿);B 组患者中恶性结节 39 例(3 例滤泡癌,31 例乳头状癌,2 例甲状腺淋巴瘤,3例甲状腺肉瘤),良性结节 17 例(4 例结节性甲状腺肿伴滤泡性腺瘤结节,13 例结节性甲状腺肿)。A组患者经 US-CNB 及 US-FNA 诊断甲状腺结节的准确率分别为 80.00%、82.00%,敏感度分别为 86.49%、83.78%,特异度分别为 61.54%、76.92%,阳性预测值为 86.49%、91.18%,阴性预测值分别为 61.54%、62.50%,卡帕一致性检验分析卡
6、帕值分别为 0.480(P=0.001),0.565(P0.001)。B 组患者经US-FNA 及 US-CNB 诊断甲状腺结节的准确率分别为 73.21%、78.57%,敏感度分别为 76.92%、79.49%,特异度分别为 64.71%、76.47%,阳性预测值为 83.33%、88.57%,阴性预测值分别为 55.00%、61.90%,卡帕一致性检验分析,卡帕值分别为 0.525(P10mm 时,应选择 US-CNB 进行诊断。【关键词】甲状腺结节;细针穿刺活检;粗针穿刺活检【文献标识码】A 【doi】10.3969/j.issn.1006-6233.2023.08.013Compari
7、son of the Value of US-FNA and US-CNB in the Diagnosis of Thyroid Nodules of Different SizesXIN Minhui,ZHANG Zhilan,LI Zhongju(Haikou Hospital,Xiangya School of Medicine,Central South University,Hainan Haikou 570208,China)【Abstract】Objective:To explore the value comparison of fine needle biopsy(US-F
8、NA)and crude needle biopsy(US-CNB)in the diagnosis of different size thyroid nodules.Methods:A total of 106 patients with thyroid nodules admitted to our hospital from March 2020 to March 2022 were selected and grouped ac-cording to the maximum diameter of the nodule,Patients with a nodule diameter
9、less than 10mm were included in group A and the maximum diameter more then 10mm was included in Group B.All patients were examined 8921 第 29 卷 第 8 期2023 年 8 月 河 北 医 学HEBEI MEDICINE Vol.29,No.8Aug.,2023 【基金项目】海南省自然科学基金面上项目,(编号:819MS140)for US-FNA and US-CNB,and postoperative pathological diagnosis wa
10、s performed.Postoperative pathological diagnosis was taken as the gold standard to explore the value of US-FNA and US-CNB in the diagnosis of thy-roid nodules of different sizes.Results:There were 37 malignant nodules(2 follicular carcinomas,28 papilla-ry carcinomas,3 thyroid lymphomas,and 4 thyroid
11、 sarcomas)and 13 benign nodules(2 nodular goiters with follicular adenomatous nodules,and 11 nodular goiters)in patients in group A.There were 39 malignant nod-ules(3 follicular carcinoma,31 papillary carcinoma,2 thyroid lymphoma,3 thyroid sarcoma)and 17 benign nodules(4 nodular goiter with follicul
12、ar adenoma nodules,13 nodular goiter)in patients in group B.The ac-curacy of diagnosis of thyroid nodules by US-CNB and US-FNA in patients in group A was 80.00%and 82.00%,sensitivity was 86.49%and 83.78%,specificity was 61.54%and 76.92%,positive predictive value was 86.49%and 91.18%,negative predict
13、ive value was 61.54%and 62.50%,and kappa Consistency test analyzed kappa values were 0.480(P=0.001),0.565(P0.001)respectively.The accuracy of diagnosis of thyroid nodules by US-FNA and US-CNB in patients in group B was 73.21%and 78.57%,the sensitivity was 76.92%and 79.49%,the specificity was 64.71%a
14、nd 76.47%,the positive predictive value was 83.33%and 88.57%,and the negative predictive value was 55.00%and 61.90%,respectively,and the kappa Consistency test was analyzed and the kappa values were 0.525(P10mm 纳入 B 组,比较两组患者的一般资料,均衡可比(P0.05)。本研究患者及家属均知情同意。见表 1。纳入标准:患者常规检查中超声提示为实性或结节表现为以实性为主;患者术后病理诊断
15、结果明确;患者临床资料完整;患者初次患病,无既往诊疗史;排除标准:患者结节表现为囊性或囊性为主;患者穿刺检查结果不明确;不具备 US-FNA 与 US-CNB 检查的指征;患者合并其他恶性肿瘤,入组前接受过放化疗治疗。表 1 两组患者一般资料比较xs,n(%)项目A 组(n=50)B 组(n=56)t/2P年龄(岁)55.598.2656.577.22-0.6470.519性别男16(32.00)19(33.93)0.0440.833女34(68.00)37(66.07)BMI 指数(kg/m2)22.142.0622.312.13-0.4170.6779921 第 29 卷 第 8 期202
16、3 年 8 月 河 北 医 学HEBEI MEDICINE Vol.29,No.8Aug.,2023 吸烟史16(32.00)15(26.79)0.3470.556饮酒史23(46.00)26(46.43)0.0020.965既往病史高血压8(16.00)9(16.07)1,二维超声考虑为恶性结节(甲状腺乳头状癌)。图 2 甲状腺细针穿刺(FNA)该结节,病理证实为甲状腺乳头状癌。1.3 统计学方法:采用 SPSS 23.0 统计软件对数据进行分析。计数资料以 n(%)表示,行2检验;以术后病理诊断为金标准,探究其诊断效能;以 P10mm 患者 56 例,为 B 组;A 组患者中恶性结节37 例(2 例滤泡癌,28 例乳头状癌,3 例甲状腺淋巴瘤,4 例甲状腺肉瘤),良性结节 13 例(2 例结节性甲状腺肿伴滤泡性腺瘤结节,11 例结节性甲状腺肿);B组患者中恶性结节39 例(3 例滤泡癌,31 例乳头状癌,2 例甲状腺淋巴瘤,3 例甲状腺肉瘤),良性结节 17 例(4 例结节性甲状腺肿伴滤泡性腺瘤结节,13 例结节性甲状腺肿)。2.2 A 组患者 US-CNB 与病理诊断结果比较:患
