摘要

目的

探究住院2型糖尿病（Type 2 diabetes mellitus，T2DM）患者患甲状腺结节（thyroid nodule，TN）的危险因素、超声及新技术（超声弹性成像技术）影像学特征与中医体质的关系。

方法

本研究采用回顾性研究方法，选取了2023年1月至2024年3月期间，在北京中医药大学第三附属医院内分泌科确诊为T2DM并接受过甲状腺超声组合检查（含常规超声与超声弹性成像）且甲功正常的189例住院患者。基于超声检查结果，患者被分为无结节组与有结节组。通过对这两组患者进行中医体质调查，并对比其临床资料，采用多因素Logistic回归模型分析了影响甲状腺结节（TN）发生的危险因素。此外，还深入探讨了不同中医体质的T2DM并发TN患者的超声及超声弹性成像影像学特征之间的关系。

结果

189例T2DM患者中无结节组118例（62.44%）与结节组71例（37.56%）临床资料比较，性别、年龄、T2DM病程、TN家族史、睡眠质量、情绪状态、LDL-C、VLDL、HbA1c、BMI差异有统计学意义（P＜0.05）；结节组中医体质以偏颇体质为主，占比为83.10%（59/71）；无结节组偏颇体质61.02%（72/118）占比低于结节组（P＜0.05）；结节组偏颇体质中以血瘀质、气郁质为主，分别占比为30.99%、26.76%，高于无结节组（P＜0.05），两组其它体质比较，差异无统计学意义（P＞0.05）；Logistic回归分析结果显示，性别（女）、年龄（≥50岁）、糖尿病病程（≥10年）、存在甲状腺结节家族史、失眠、易怒、超重肥胖、低密度脂蛋白胆固醇（Low-Density Lipoprotein Cholesterol，LDL-C）异常、极低密度脂蛋白（very low density lipoprotein，VLDL）异常、糖化血红蛋白（glycosylated hemoglobin，HbA1c）异常、气郁质、血瘀质为影响糖尿病患者并发甲状腺结节危险因素（P<0.001），平和质为保护因素（P<0.001）；平和质、偏颇质患者超声特征对比：结节结构、结节回声、结节边界、纵横比、微钙化比较有统计学差异（P＜0.05），偏颇质以实性、低回声或极低回声，边界不清、纵横比≥1、结节微钙化为主（P＜0.05）;偏颇质患者相较于平和质患者具有更高的应变力弹性成像评分（strain elastography，SE）评分（P<0.05）。

结论

在住院T2DM患者中偏颇体质较平和体质更易患甲状腺结节，T2DM并发TN患者超声影像学表现及超声弹性成像评分与患者中医体质类型存在一定联系，与年龄、性别、糖尿病病程、TN家族史、睡眠质量、情绪状态、LDL-C、VLDL、HbA1c、体质量指数（body mass index，BMI）、中医体质（气郁质、血瘀质）等多因素相关。

Abstract

Objective

To investigate the relationship between traditional Chinese medicine (TCM) constitution and the risk factors, ultrasound, and ultrasound elastography imaging characteristics of thyroid nodules (TN) in patients with Type 2 diabetes mellitus (T2DM).

Methods

This study employed a retrospective research method, selecting 189 inpatients diagnosed with T2DM at the Endocrinology Department of the Beijing University of Chinese Medicine Third Affiliated Hospital from January 2023 to March 2024. These patients had undergone a thyroid ultrasound combination examination (including conventional ultrasound and ultrasound elastography) and had normal thyroid function. Based on the results of the ultrasound examination, patients were divided into a nodule-free group and a nodule-present group. Through the investigation of traditional Chinese medicine (TCM) constitution in these two groups and the comparison of their clinical data, this study used a multifactorial Logistic regression model to analyze the risk factors affecting the occurrence of thyroid nodules (TN). In addition, the study further explored the relationship between the ultrasound and ultrasound elastography imaging characteristics of T2DM patients with TN of different TCM constitutions.

Results

In a cohort of 189 patients with T2DM, the nodule-free group consisted of 118 cases (62.44%) and the nodule group comprised 71 cases (37.56%). A comparative analysis of clinical data revealed statistically significant differences in gender, age, duration of T2DM, family history of thyroid nodules (TN), sleep quality, emotional status, low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein (VLDL), glycated hemoglobin (HbA1c), and body mass index (BMI) (P<0.05). The nodule group predominantly exhibited a deviated constitution in traditional Chinese medicine (TCM), accounting for 83.10% (59/71). The proportion of deviated constitution in the nodule-free group was 61.02% (72/118), which was significantly lower than that in the nodule group (P<0.05). Within the deviated constitution of the nodule group, blood stasis and qi stagnation were predominant, representing 30.99% and 26.76%, respectively, and were higher than in the nodule-free group (P<0.05). No statistically significant differences were found in other constitutions between the two groups (P>0.05).Logistic regression analysis indicated that female gender, age ≥50 years, diabetes duration ≥10 years, family history of thyroid nodules, insomnia, irritability, overweight/obesity, abnormal LDL-C, abnormal VLDL, abnormal HbA1c, qi stagnation constitution, and blood stasis constitution were risk factors for the co-occurrence of thyroid nodules in diabetic patients (P<0.001), while a balanced constitution in TCM was a protective factor (P<0.001). When comparing ultrasound characteristics between patients with balanced and deviated constitutions, there were statistically significant differences in nodule structure, echogenicity, boundary, aspect ratio, and microcalcification (P<0.05). Patients with deviated constitution predominantly exhibited solid nodules with low or very low echogenicity, unclear boundaries, an aspect ratio ≥1, and microcalcifications (P<0.05). Patients with deviated constitution also had higher strain elastography (SE) scores compared to those with a balanced constitution (P<0.05).

Conclusion

In patients with T2DM, a deviated constitution is more likely to be associated with the co-occurrence of thyroid nodules than a balanced constitution. The ultrasound imaging and ultrasound elastography scores of T2DM patients with TN are related to the type of TCM constitution and are associated with multiple factors such as age, gender, diabetes duration, TN family history, sleep quality, emotional state, LDL-C, VLDL, HbA1c, BMI, and TCM constitution (qi stagnation, blood stasis).