摘要
背景亚急性甲状腺炎(SAT)患者临床表现变化多样,容易造成误诊及漏诊,严重影响患者生活质量。因此,寻找一种简单、准确的方法以早期辅助诊断该病显得尤为重要。目的探讨全身炎症综合指数(AISI)在SAT辅助诊断中的临床应用价值。方法回顾性选择2021年7月—2023年7月在浙江省人民医院门诊及住院的143例成人SAT初诊患者为SAT组;同时纳入142例本院健康体检者为健康对照组。分析两组的甲状腺功能、全血细胞计数和红细胞沉降率(ESR)水平,计算各组AISI、中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR),分析SAT患者AISI与NLR、PLR、ESR和甲状腺功能相关指标的相关性。采用多因素Logistic回归分析探讨发生SAT的影响因素,绘制AISI诊断SAT的受试者工作特征(ROC)曲线,分析其诊断效能。结果SAT组患者的白细胞计数、中性粒细胞计数、单核细胞计数、血小板计数、NLR、PLR和AISI均高于健康对照组,淋巴细胞计数低于健康对照组(P<0.05)。SAT组患者AISI与NLR(r_(s)=0.772,P<0.05)、PLR(r_(s)=0.531,P<0.05)、ESR(r_(s)=0.446,P<0.05)、游离三碘甲状腺原氨酸(FT_(3))(r_(s)=0.369,P<0.05)、游离甲状腺素(FT_(4))(r_(s)=0.421,P<0.05)和甲状腺球蛋白(Tg)(r_(s)=0.437,P=0.029)呈正相关,AISI与促甲状腺激素(TSH)(r_(s)=-0.386,P<0.05)呈负相关。多因素Logistic回归分析显示,AISI(OR=1.006,P<0.05)、ESR(OR=1.072,P<0.05)、FT_(4)(OR=1.574,P<0.05)是患者发生SAT的独立预测因子。ROC曲线分析显示,AISI辅助诊断SAT的最佳截断值为223.67,灵敏度为86.01%,特异度为84.51%,ROC曲线下面积(AUC)为0.903,诊断效能优于NLR(Z=2.953,P=0.003)和PLR(Z=4.792,P<0.001),与ESR相当(Z=0.366,P=0.715)。AISI和ESR联合检测辅助诊断SAT的灵敏度为90.91%,特异度为91.55%,AUC大于AISI和ESR单独检测(Z=3.164,P<0.001;Z=2.811,P=0.005)。SAT复发患者的AISI与无复发的患者AISI[436.65(269.38,807.17)与563.97(361.51,776.96)]比较,差异无统计学意义(Z=1.083,P=0.279)。结论SAT患者AISI显著升高,作为一种简单、实用的新指标,AISI可用于SAT辅助诊断。
Background The clinical manifestations of subacute thyroiditis(SAT)vary a lot,easily leading to misdiagnosis and missed diagnosis,and seriously affect the quality of life.Therefore,it is particularly important to find a simple and accurate method to assist in the early diagnosis of SAT.Objective To explore the clinical application value of aggregate index of systemic inflammation(AISI)in the auxiliary diagnosis of SAT.Methods A total of 143 adults with newly diagnosed SAT in Zhejiang Provincial People's Hospital from July 2021 to July 2023 were retrospectively selected as the SAT group.At the same time,142 healthy volunteer_(s) receiving physical examinations in our hospital were included in the control group.The thyroid function,blood routine and erythrocyte sedimentation rate(ESR)of the two groups were retrospectively analyzed.AISI,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were calculated.The correlation of AISI with NLR,PLR,ESR and thyroid function indicator_(s) was analyzed.Multivariate Logistic regression was used to analyze the influencing factor_(s) of SAT,and the receiver operating characteristic(ROC)curve was plotted to analyze the diagnostic performance of AISI in SAT.Results The white blood cell count,neutrophil count,monocyte count,platelet count,AISI,NLR and PLR in the SAT group were significantly higher than those of the control group(all P<0.05),and the lymphocyte count was significantly lower(P<0.05).AISI in the SAT group was positively correlated with NLR(r_(s)=0.772,P<0.05),PLR(r_(s)=0.531,P<0.05),ESR(r_(s)=0.446,P<0.05),free triiodothyronine(FT_(3),r_(s)=0.369,P<0.05),free thyroxine(FT_(4),r_(s)=0.421,P<0.05)and thyroglobulin(Tg,r_(s)=0.437,P=0.029),but negatively correlated with thyroid stimulating hormone(TSH,r_(s)=-0.386,P<0.05).Multivariate Logistic regression analysis showed that AISI(OR=1.006,P<0.05),ESR(OR=1.072,P<0.05)and FT_(4)(OR=1.574,P<0.05)were independent predictor_(s) of SAT patients.ROC curve analysis showed that the optimal cutoff value of AISI in the auxiliary diagnosis of SAT was 223.67,with a sensitivity of 86.01%,and a specificity of 84.51%.The area under the curve(AUC)of AISI was 0.903,showing a better diagnostic performance than NLR(Z=2.953,P=0.003)and PLR(Z=4.792,P<0.001),but equivalent to ESR(Z=0.366,P=0.715).The sensitivity of AISI combined with ESR in diagnosing SAT was 90.91%,and the specificity was 91.55%,showing a larger AUC than AISI or ESR detection alone(Z=3.164,P<0.001;Z=2.811,P=0.005).There was no significant difference in the AISI between recurrent and non-recurrent SAT patients[436.65(269.38,807.17)vs.563.97(361.51,776.96),Z=1.083,P=0.279].Conclusion AISI significantly increases in SAT patients,serving as a simple and practical indicator used to the auxiliary diagnosis of SAT.
作者
韩超
占小飞
严沁
俞鑫
童燕
庞珍珍
解鸿翔
HAN Chao;ZHAN Xiaofei;YAN Qin;YU Xin;TONG Yan;PANG Zhenzhen;XIE Hongxiang(Department of Clinical Laboratory,Joint Service Support Force 903 Hospital,Hangzhou 310007,China;School of Laboratory Medicine and Bioengineering,Hangzhou Medical College,Hangzhou 311399,China;Laboratory Medicine Center,Department of Clinical Laboratory,Zhejiang Provincial People's Hospital(Affiliated People's Hospital),Hangzhou Medical College,Hangzhou 310014,China)
出处
《中国全科医学》
北大核心
2025年第18期2241-2246,2252,共7页
Chinese General Practice
基金
浙江省教育厅一般科研项目(Y202146133)
浙江省高校基本科研经费专项(KYYB202216)
浙江省中医药科技计划项目(2023ZL009)
浙江省医药卫生科技计划项目(2021KY017,2022KY027)
浙江省自然科学基金资助项目(LMS25H080001)。
