Wang Kun, Yang Yu, Wu Yang, Chen Jie, Zhang Danyu, Liu Chao
Department of Endocrinology, The First Clinical College, Nanjing University of Chinese Medicine, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 138 Xianlin Dadao Road, Nanjing, 210023, China.
Endocrine. 2015 Mar;48(2):603-14. doi: 10.1007/s12020-014-0342-7. Epub 2014 Jul 11.
The purpose of the study was to explore the association of menstrual and reproductive factors with thyroid nodules in Chinese women older than 40 years of age. A questionnaire was completed by 6,571 women aged 40 years or older in a community-based epidemiological investigation of thyroid nodules conducted from June to November 2011 in Nanjing City. Thyroid nodules were measured by ultrasound. The Thyroid Imaging Reporting and Data System score was used to differentiate between benign and possibly malignant nodules. Menopausal age (>55 vs. <50 years: RR = 1.17, 95 % CI 1.00-1.34) and number of reproductive years (>40 vs. <35 years: RR = 1.12, 95 % CI 1.01-1.24) increased the risk of thyroid nodules, but were not associated with suspected malignant nodules. Women who experienced more pregnancies (≥5 vs. ≤1: RR = 2.09, 95 % CI 1.79-2.40) and abortions (≥3 vs. 0: RR = 1.61, 95 % CI 1.41-1.81) were prone to development of thyroid nodules, and more likely to form suspected malignant nodules (pregnancies, RR = 3.59, 95 % CI 1.60-7.20; abortions, RR = 2.36, 95 % CI 1.31-4.06). Furthermore, higher risks of thyroid nodules (RR = 1.36, 95 % CI 1.14-1.59) and suspected malignant nodules (RR = 2.80, 95 % CI 1.08-6.53) were observed in women who had undergone artificial compared with natural abortion. Periods of elevated estrogen and progesterone levels in women, such as pregnancy, were the key occasions for occurrence of both benign and suspiciously malignant thyroid nodules, while longer lifetime length of exposure to female sex hormones might promote the growth of thyroid nodules.
该研究的目的是探讨月经和生殖因素与40岁以上中国女性甲状腺结节之间的关联。在2011年6月至11月于南京市开展的一项基于社区的甲状腺结节流行病学调查中，6571名40岁及以上的女性完成了一份调查问卷。通过超声测量甲状腺结节。采用甲状腺影像报告和数据系统（TI-RADS）分类来区分良性和可疑恶性结节。绝经年龄（>55岁与<50岁：风险比[RR]=1.17，95%置信区间[CI]1.00-1.34）和生育年限（>40年与<35年：RR=1.12，95%CI 1.01-1.24）会增加甲状腺结节的风险，但与可疑恶性结节无关。经历更多次怀孕（≥5次与≤1次：RR=2.09，95%CI 1.79-2.40）和流产（≥3次与0次：RR=1.61，95%CI 1.41-1.81）的女性更容易发生甲状腺结节，且更有可能形成可疑恶性结节（怀孕，RR=3.59，95%CI 1.60-7.20；流产，RR=2.36，95%CI 1.31-4.06）。此外，与自然流产的女性相比，人工流产的女性发生甲状腺结节（RR=1.36，95%CI 1.14-1.59）和可疑恶性结节（RR=2.80，95%CI 1.08-6.53）的风险更高。女性雌激素和孕激素水平升高的时期，如怀孕，是良性和可疑恶性甲状腺结节发生的关键时期，而更长时间暴露于女性性激素可能会促进甲状腺结节的生长。
