甲状腺功能正常的桥本甲状腺炎患者进展为甲状腺功能减退的风险预测模型建立及验证*

作者：王琪琪1,2，张武平2，李心爱3，杨 燕2，董冰艳2，王朝歆2

单位：1.北京中医药大学孙思邈医院，陕西 铜川 727100； 2.北京中医药大学东方医院，北京 100071； 3.北京中医药大学，北京 100029

引用：引用：王琪琪，张武平，李心爱，杨燕，董冰艳，王朝歆.甲状腺功能正常的桥本甲状腺炎患者进展为甲状腺功能减退的风险预测模型建立及验证[J].中医药导报,2026,32(1):124-128.

DOI：10.13862/j.cn43-1446/r.2026.01.021

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摘要：目的：运用中西医多模态参数构建甲状腺功能正常的桥本甲状腺炎（HT）进展为甲状腺功能减退症（甲减）的风险预测模型，并验证其预测效能。方法：对2020年1月至2022年1月诊治的200例甲状腺功能正常HT患者的临床资料开展研究。通过医院电子病历系统获取患者的完整资料。依照7:3比例将纳入病例随机分成模型组与验证组，分别为140例、60例。所有患者接受3年随访，根据有无进展为甲减，将模型组分为甲减组、无甲减组，对比分析两组患者中西医临床参数，开展单因素及多因素Logistic回归模型分析，通过R软件构建预测甲状腺功能正常HT患者进展为甲减的列线图模型，以验证组检验预测效能，计算受试者工作特征曲线下面积（AUC），并行H-L校准度检验。结果：200例患者中，进展为甲减49例（24.50%），其中模型组36例、验证组13例。以模型组病例进行单因素分析，甲减组与无甲减组患者的年龄、性别、中医证型、合并肝肾病、腺体血流丰富度、腺体回声状态及血清FT3、FT4、TT3、TT4、TRAb及TSH比较，差异均有统计学意义（P＜0.05）。通过多因素Logistic回归分析，年龄、中医证型、肝脾证素、湿证素、合并肝肾病、腺体CDFI、血清FT3、TSH变化是独立风险因素（P＜0.05）；基于独立风险因素绘制列线图模型，以验证组分析，该模型AUC为0.938，且H-L检验显示具有良好一致性（χ2=3.826，P＞0.05）。结论：基于中西医多模态参数构建的甲状腺功能正常HT患者进展为甲减风险预测模型有良好的预测效能，可为临床早期预测和防治提供依据。

关键词：桥本甲状腺炎；甲状腺功能减退症；预测模型；多模态参数

Abstract：

Objective: To construct and validate a risk prediction model for the progression of Hashimoto's thyroiditis (HT) with normal thyroid function to hypothyroidism using multimodal parameters from Chinese and Western medicine. Methods: A retrospective study was conducted on the clinical data of 200 HT patients with normal thyroid function treated from January 2020 to January 2022. Complete patient data were obtained from the hospital's electronic medical record system. According to a 7:3 ratio, the included cases were randomly divided into a model group (140 cases) and a validation group (60 cases). All patients were followed up for 3 years. Based on whether they progressed to hypothyroidism, the model group was divided into a hypothyroidism subgroup and a non-hypothyroidism subgroup. Clinical parameters from Chinese and Western medicine were compared and analyzed between the two subgroups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. R software was used to construct a nomogram model predicting the progression to hypothyroidism. The prediction efficiency was validated using the validation group, calculating the area under the receiver operating characteristic curve (AUC) and performing the Hosmer-Lemeshow (H-L) goodness-of-fit test. Results: Among the 200 patients, 49 (24.50%) progressed to hypothyroidism, including 36 in the model group and 13 in the validation group. Univariate analysis of the model group showed statistically significant differences in age, sex, TCM syndrome type, comorbid liver/kidney disease, glandular blood flow richness, glandular echo distribution, serum FT3, FT4, TT3, TT4, TRAb and TSH between the hypothyroidism and non-hypothyroidism subgroups (P<0.05). Multivariate logistic regression analysis identified age, TCM syndrome type, liver/spleen syndrome elements, dampness syndrome element, comorbid liver/kidney disease, glandular color Doppler flow imaging (CDFI) pattern, serum FT3, and TSH as independent risk factors (P<0.05). A nomogram model was constructed based on these independent risk factors. Validation group analysis showed the model had an AUC of 0.938 and good consistency in the H-L test (χ2=3.826, P>0.05). Conclusion: The risk prediction model for hypothyroidism progression in HT patients with normal thyroid function, based on multimodal parameters from Chinese and Western medicine, demonstrates good predictive efficacy and can serve as a basis for early clinical prediction and prevention.

Key words：Hashimoto's thyroiditis; hypothyroidism; prediction model; multimodal parameters

发布时间：2026-01-30

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