【目的】 分析甲状腺结节患者中性粒细胞与淋巴细胞比值（NLR）、血小板淋巴细胞比值（PLR）、单核细胞与淋巴细胞比 值（MLR）、全身免疫炎症指数（SII）等炎症指标与不同中医证型及甲状腺结节超声恶性危险分层中国指南（C-TIRADS）分类和 结节性质的相关性，为指导中医辨证及治疗提供依据，并为甲状腺结节患者的 C-TIRADS 分类及结节性质评估提供依据。 【方法】 回顾性分析2021年1月至2024年1月期间在广州中医药大学附属广州中西医结合医院（即广州市中西医结合医院）普外 科住院诊断为甲状腺结节且行甲状腺切除术的140例患者。按照甲状腺结节不同中医证型、C-TIRADS分类、甲状腺结节性质 分组，采用χ2 检验和秩和检验分析各项临床指标与中医证型及C-TIRADS分类和甲状腺结节性质的关系，采用 Spearman 相关 系数分析临床指标与C-TIRADS分类和甲状腺结节性质的相关性，利用受试者工作特征（ROC）曲线分析NLR、MLR、PLR、SII 等对甲状腺结节患者结节性质的预测价值，并以约登指数确定最佳预测临界值。【结果】（1）根据中医辨证分型标准，分为气郁痰 阻证72例，痰结血瘀证65例，心肝阴虚证3例（由于心肝阴虚证的病例数太少，故不作分析）。（2）气郁痰阻证患者的游离T3 （FT3）、游离 T4（FT4）水平高于痰结血瘀证，抗甲状腺过氧化物酶抗体（A-TPO）、抗甲状腺球蛋白抗体（A-TG）、中性粒细 胞（NEU）、NLR、SII 水平低于痰结血瘀证，差异均有统计学意义（P < 0.05 或 P < 0.01）。（3）C-TIRADS3分类的NLR、PLR、 SII水平低于C-TIRADS4分类，差异均有统计学意义（P < 0.05或P < 0.01）；而C-TIRADS3分类与C-TIRADS4分类的MLR水平比 较，差异无统计学意义（P > 0.05）。（4）良性结节患者的NLR、PLR、MLR、SII水平均低于恶性结节患者，差异均有统计学意义 （P < 0.05或P < 0.01）。（5）经Spearman相关性分析，NLR、PLR、SII与患者结节C-TIRADS分类呈正相关性，NLR、PLR、MLR、 SII与患者结节性质呈正相关性，差异均有统计学意义（P < 0.05或P < 0.01）。（6）高风险甲状腺结节患者的NLR、MLR、PLR、SII 水平对结节性质有一定的预测价值，曲线下面积（AUC）分别为0.645、0.641、0.604、0.716，差异均有统计学意义（P < 0.05或 P < 0.01）。高风险甲状腺结节患者的NLR、MLR、PLR、SII水平对结节性质的预测，最佳截断值及其对应的敏感度和特异性分 别为：2.261（0.551，0.791）、138.108（0.735，0.527）、5.132（0.714，0.495）、493.114（0.776，0.615）；约登指数分别为：0.342、 0.262、0.209、0.391。【结论】FT3、FT4与甲状腺结节患者气郁痰阻证呈正相关；A-TPO、A-TG、NEU、NLR、SII值与甲状腺结 节患者痰结血瘀证呈正相关。NLR、PLR、SII值与甲状腺结节患者不同C-TIRADS分类呈正相关；NLR、PLR、MLR、SII值与 恶性甲状腺结节呈正相关。NLR、MLR、PLR、SII对预测甲状腺结节患者甲状腺结节性质效果良好。

Objective To analyze the correlation of inflammatory indicators of neutrophil-to-lymphocyte ratio （NLR），platelet-to-lymphocyte ratio（PLR），monocyte-to-lymphocyte ratio（MLR），and systemic immune-inflammation index（SII）with traditional Chinese medicine（TCM）syndrome types and Chinese version of Thyroid Imaging Reporting and Data System（C-TIRADS）classification and properties of nodules in the patients with thyroid nodules（TN），thus to provide evidence for guiding TCM syndrome differentiation and treatment，and for assessing C-TIRADS classification and properties of the nodules in patients with TN. Methods A retrospective analysis was carried out in 140 inpatients who were diagnosed as TN and had underwent thyroidectomy during the period of January 2021 to January 2024 in the Department of General Surgery of Guangzhou Integrated Chinese and Western Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine （Guangzhou Hospital of Integrated Traditional and West Medicine）. The patients were allocated to various group with reference to TCM syndrome types，C-TIRADS classification，and the properties of TN. The correlation of each clinical indicator with TCM syndrome types and C-TIRADS classification and properties of TN was analyzed. The Spearman correlation coefficient was employed for evaluating the correlation of clinical indicators with the C-TIRADS classification and properties of TN， receiver operating characteristic curve（ROC） was used to analyze the predictive value of NLR，MLR，PLR，and SII for the properties of nodules in patients with TN，and the Youden􀆳 s Index was used to determine the cutoff value for optimal prediction. Results（1）According to the criteria of TCM syndrome differentiation，72 cases were differentiated as qi stagnation and phlegm obstruction syndrome，65 cases as phlegm accumulation and blood stasis syndrome，and 3 cases as heart-liver yin deficiency syndrome. For the number of cases of heart-liver yin deficiency syndrome was too small，only the first two syndromes were included for the analysis.（2）The levels of free T3（FT3）and free T4（FT4）in the patients of qi stagnation and phlegm obstruction syndrome were higher， and the levels of anti-thyroid peroxidase antibody （A-TPO）， antithyroglobulin antibody（A-TG）， neutrophil（NEU）， NLR， and SII were lower than those in the patients of phlegm accumulation and blood stasis syndrome，the differences being all statistically significant（P < 0.05 or P < 0.01）.（3）The levels of NLR，PLR，and SII in the patients with C-TIRADS3 classification were lower than those in the patients with C-TIRADS4 classification，the differences being all statistically significant（P < 0.05 or P < 0.01）； no statistically significant difference of MLR was presented between the patients with C-TIRADS3 classification and those with C-TIRADS4 classification（P > 0.05）.（4）The levels of NLR，PLR，MLR，and SII in patients with benign nodules were lower than those in patients with malignant nodules，the differences being statistically significant（P < 0.05 or P < 0.01）.（5）The Spearman correlation analysis showed that NLR，PLR， and SII were positively correlated with the C-TIRADS classification of the nodules，and NLR，PLR，MLR，and SII were positively correlated with the properties of the nodules，the differences being all statistically significant （P < 0.05 or P < 0.01）.（6）The levels of NLR，MLR，PLR，and SII in patients with high-risk TN exerted a certain predictive value for the properties of the nodules，and their area under the curve（AUC）was 0.645，0.641， 0.604，and 0.716，respectively，the differences being statistically significant（P < 0.05 or P < 0.01）. For the prediction of nodule properties by NLR，MLR，PLR，and SII levels in patients with high-risk TN，their cutoff values and the corresponding sensitivities and specificities were 2.261（0.551，0.791），138.108（0.735，0.527）， 5.132（0.714，0.495），493.114（0.776 ，0.615），respectively；and their Youden􀆳s Index was 0.342，0.262， 0.209，0.391，respectively. Conclusion The results indicated that in patients with TN，the FT3 and FT4 levels are positively correlated with the qi stagnation and phlegm obstruction syndrome；the values of A-TPO，A-TG， NEU，NLR，and SII are positively correlated with the phlegm accumulation and blood stasis syndrome ； NLR ， PLR and SII values are positively correlated with C-TIRADS classification；NLR，PLR，PLR，SII values are positively correlated with malignant TN.NLR，MLR，PLR，SII values exert high efficiency for the prediction of the properties of nodules in patients with TN.

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广东省中医药局科研项目（编号：20171221）；广州市花都区医疗卫生一般科研专项（编号：22-HDWS-088）