广州医科大学学报

目的：探讨年龄、超声特征（微钙化、Alder血流分级）及血清TSH在甲状腺结节良恶性鉴别中的价值，构建联合诊断模型。方法：回顾性分析本院95例经病理确诊的甲状腺TI-RADS 4类结节患者（良性组60例，恶性组35例）临床资料，收集术前常规超声特征（形态、边界、钙化、纵横比、血流等）、血清TSH检测结果。通过Logistic回归筛选独立预测因素，并绘制ROC曲线评估诊断效能。结果：恶性组年龄更低（46.86±12.00比54.9±11.93岁，P=0.002），微钙化（54.3%比20.0%）、Alder血流2～3级（71.4%比10.0%）比例更高（均P<0.05）。Logistic回归显示年龄（OR=0.925）、微钙化（OR=8.489）、血流分级（OR=30.097）为独立预测因素，联合模型AUC达0.931，敏感性和特异性分别为85.71%和93.33%。恶性结节组血清TSH显著高于良性组，Z=-1.98,P<0.05。联合模型（年龄+微钙化+高血流分级）鉴别良恶性的AUC达0.93（灵敏度85.7%，特异性93.3%），显著优于单一指标（年龄AUC:0.686；微钙化AUC:0.671；高血流分级：AUC:0.807,P<0.05）。结论：年龄、微钙化及血流分级联合检测可显著提高甲状腺结节良恶性鉴别能力。

Objective:To investigate the diagnostic value of age,ultrasound features(microcalcifications,Alder blood flow classification),and serum TSH in differentiating benign and malignant thyroid nodules,and to construct a combined diagnostic model.Methods:Clinical data of 95 patients with pathologically confirmed thyroid TI-RADS 4 nodules(60 benign,35 malignant) were retrospectively analyzed. Preoperative conventional ultrasound features(shape,margin,calcification,aspect ratio,blood flow,etc.) and serum TSH levels were collected. Independent predictors were identified using Logistic regression,and ROC curves were plotted to evaluate diagnostic performance.Results:The malignant group had a younger age(46.86±12.00 vs. 54.9±11.93 years,P=0.002),higher rates of microcalcifications(54.3% vs 20.0%)and Alder blood flow grades 2–3(71.4% vs 10.0%)(all P<0.05). Logistic regression identified age(OR=0.925),microcalcifications(OR=8.489),and blood flow grade(OR=30.097) as independent predictors. The combined model achieved an AUC of 0.931,with sensitivity and specificity of 85.71% and93.33%,respectively. Serum TSH in the malignant group was significantly higher than in the benign group(Z=-1.98,P<0.05). The combined model(age + microcalcifications + high blood flow grade) showed superior diagnostic performance(AUC:0.93,sensitivity:85.7%,specificity:93.3%) compared to individual indicators(age AUC:0.686;microcalcifications AUC:0.671;high blood flow grade AUC:0.807,P<0.05).Conclusion:The combined evaluation of age,microcalcifications,and blood flow grade significantly improves the differentiation of benign and malignant thyroid nodules.