【作者】 苗彦玲；

【导师】 张彤迪；

【作者基本信息】 河北医科大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 目的:探讨超声在甲状腺功能减退症诊断中的临床应用价值。方法:正常对照组为健康志愿者20例,其中男4例,女16例。实验组为2009年1月至2010年1月经河北医科大学第二医院确诊的未经治疗的甲状腺功能减退症患者40例(排除继发性甲状腺功能减退症及慢性肝病或肾上腺疾病引起的甲状腺功能减退症),患者病程<3个月,按甲状腺功能减低程度分为亚临床甲减组及临床甲减组(亚临床甲减组血清学检查:TSH↑,而FT4、FT3在正常参考范围内,临床甲减组血清学检查: TSH↑,FT3↓,FT4↓),每组病人20例,临床甲减组患者抗甲状腺过氧化物酶抗体>1300U/ml,均为桥本甲状腺炎导致的临床甲减。所有受检者均在河北医科大学第二医院检测甲状腺功能,随即进行超声波检查。实验仪器采用飞利浦公司的IU22彩色多普勒超声诊断仪,高频探头,探头频率为5～12MHz,取样容积约1.0mm,声束与血流束方向夹角<60°,安静状态下,患者取仰位,头略向后仰,充分暴露颈部。用二维超声常规观察甲状腺声像图特征并测量双侧甲状腺长径(D1)、横径(D2)、厚径(D3)各数值均连续测3次取平均值。应用彩色多普勒血流图观察甲状腺内血流分布情况,测量甲状腺上动脉管径。应用频谱多普勒于甲状腺上动脉入甲状腺上极前5～10mm处测量其收缩期最高流速(Vmax)及阻力指数(RI),连续测3次取平均值。将各组两侧叶甲状腺上动脉管径,Vmax、RI相加,求单侧叶各指标的平均值。根据V单=(∏/6)×D1×D2×D3,计算甲状腺单侧叶体积V=(VL+VR)/2。应用SPSS11.5统计软件对所得数据进行统计分析。数据用均数±标准差表示,多组间比较用方差分析和F检验,两两比较用q检验,相关性比较做相关分析,计数资料用卡方检验,以P<0.05为差异有统计学意义。结果:1超声表现1.1二维声像图特征1.1.1甲状腺内部回声特征对照组甲状腺两侧叶对称,外形规则,包膜完整,被膜光滑,腺体内成中等回声,光点细小均匀。亚临床甲减组甲状腺腺体不同程度增大,形态饱满,腺体内部回声减低,光点增粗且分布欠均匀。临床甲减组甲状腺腺体增大,内部回声不均匀,明显减低,部分患者甲状腺内可见粗细不等的不规则网格状高回声光带。三组之间比较差异均有统计学意义(P<0.05)。1.1.2甲状腺各径线及体积亚临床甲减组与临床甲减组甲状腺各径线及体积与对照组相比较差异均有统计学意义(P<0.05),均较对照组增大。亚临床甲减与临床甲减组比较,除甲状腺厚径差异无统计学意义(P>0.05)外,余甲状腺径线及体积差异均有统计学意义(P<0.05)。1.2彩色多普勒超声特征1.2.1甲状腺上动脉管径亚临床甲减组及临床甲减组与对照组比较,甲状腺上动脉管径的差异有统计学意义(P<0.05),亚临床甲减组及临床甲减组均较对照组增宽,亚临床甲减组与临床甲减组比较差异亦有统计学意义(P<0.05),临床甲减组增宽更加明显。1.2.2甲状腺组织内血流特征对照组甲状腺组织内血流信号不丰富,可见稀疏分布的点、束状血流信号。亚临床甲减组、临床甲减组患者中绝大多数甲状腺腺体内血流信号增多,部分患者甲状腺内布满彩色血流。亚临床甲减组及临床甲减组与对照组比较差异有统计学意义(P<0.05),亚临床甲减组与临床甲减组之间比较差异无统计学意义(P>0.05)。1.3频谱多普勒超声表现1.3.1甲状腺上动脉收缩期最高流速(Vmax)亚临床甲减组及临床甲减组与对照组比较差异有统计学意义(P<0.05),其流速均较对照组增高,亚临床甲减组与临床甲减组比较差异无统计学意义(P>0.05)。1.3.2阻力指数(RI)对照组、亚临床甲减组及临床甲减组三组甲状腺上动脉阻力指数差异无统计学意义(P>0.05)。1.3.3频谱多普勒曲线特征对照组多普勒频谱形态呈低速低阻型。亚临床甲减组、临床甲减组流速均较对照组增高,亦均为低阻型频谱,频谱波峰较钝,舒张期流速下降较缓慢、均匀。2相关性研究2.1甲状腺上动脉收缩期最高流速(Vmax)与甲状腺单侧叶体积(V)的相关性研究分别将亚临床甲减组、临床甲减组的甲状腺上动脉收缩期最高流速与甲状腺单侧叶体积做直线相关分析,结果显示两者均为正相关,相关系数分别为:0.62、0.71。2.2甲状腺上动脉管径与促甲状腺激素水平的相关性研究分别将亚临床甲减组、临床甲减组的甲状腺上动脉管径与促甲状腺激素水平做直线相关分析,结果两者亦为正相关,相关系数分别为:0.59、0.67。结论:1甲状腺功能减退症患者(病程<3个月)甲状腺内部回声为光点增粗伴局限性或弥漫性回声减低,亚临床甲减患者甲状腺内回声弥漫性减低者以无高回声光带为主,临床甲减患者以弥漫性回声减低伴高回声光带形成者居多。因此甲状腺内回声特征可以作为甲状腺功能减退症诊断的一项参考指标。2甲状腺功能减退症患者(病程<3个月)甲状腺各径线及体积增大,临床甲减增大更明显,上述指标可反映甲状腺功能状态,可对病情发展及治疗效果进行评估。3甲状腺功能减退症患者(病程<3个月)甲状腺组织内也可出现血流信号增多的“火海征”现象,甲状腺上动脉管径增宽,流速增高,但亚临床甲减与临床甲减两组间无显著性差异,故甲状腺组织内血流特征尚不能反映甲状腺功能减退的程度。4甲状腺功能减退症患者(病程<3个月)甲状腺上动脉收缩期最高流速与甲状腺单侧叶体积呈正相关。5甲状腺功能减退症患者(病程<3个月)甲状腺上动脉管径与促甲状腺激素水平呈正相关。更多还原

【Abstract】 Objective: evaluation of the diagnostic role of ultrasonography for hypothyroidism.Methods: The normal control group for the years of healthy volunteers,male 4 and female 16. the experimental group,diagnosed untreated patients with hypothyroidism in January 2009 to 2010 in the second hospital of Hebei Medical University, (excluding secondary hypothyroidism, or adrenal disease and chronic liver disease caused by hypothyroidism),Course of disease in patients less than 3 months, by reducing the level of thyroid function is divided into sub-clinical hypothyroidism and clinical hypothyroidism group,(Subclinical hypothyroidism group serology: TSH↑, FT4、FT3 in the normal frame of reference, the review of clinical hypothyroidism group serology search: TSH↑, FT3↓, FT4↓),20 patients in each group of patients, clinical hypothyroidism in patients with anti-thyroid peroxidase antibody<1300U/ml, both clinical hypothyroidism caused by Hashimoto’s thyroiditis. the thyroid function test before ultrasound examination. Philips IU22 using color Doppler ultrasonic diagnostic apparatus, high-frequency probe, probe frequency of 7.5MHz, sample volume of about 1.0mm, sound beam and blood flow in the direction of beam angle< 60°. In a quiet state, the patient admitted supine position, head slightly thrown back, fully exposed neck. Conventional two-dimensional ultrasound observation and measurement of thyroid sonographic features of bilateral thyroid length (D1), width (D2), thickness (D3), continuous measurement of three times averaged.Color Doppler flow imaging observation of the thyroid gland blood flow distribution measured the superior thyroid artery diameter. Application of spectral doppler in the superior thyroid artery into the upper pole of thyroid gland before the 5 ~ 10mm measured at the systolic maximum velocity (Vmax) and resistance index (RI), continuous measurement of three times averaged. Each of the groups on both sides of superior thyroid artery diameter, Vmax, RI are added together, seeking unilateral leaves the average of each index. According to V = (Π/ 6)×D1×D2×D3, the calculation of unilateral thyroid volume V = (VL + VR) / 2.Application SPSS11.5 statistical software to conduct statistical analysis of the data obtained. Data with mean±standard deviation, said multiple comparison using analysis of variance and F test, pairwise comparison test with q test, the relevant comparison to do linear correlation analysis, count data using chi-square test,it was a statistical significance when P <0.05.Results:1 Ultrasound examination results1.1 Two-dimensional ultrasonographic features1.1.1 The internal echo characteristics of thyroid glandThyroid control group on both sides of leaf symmetry, shape rules, capsule integrity, and capsule smooth, glands into a medium-echo, even a small spot. Subclinical hypothyroidism thyroid gland increased to varying degrees, form full, glands of internal echo reduced spot thickening and less evenly distributed. Clinical hypothyroidism thyroid gland increased, non-uniform internal echo is obviously reduced, in some patients the thickness of the thyroid gland can be seen, ranging from irregular grid of high echo belt. Difference between the three groups were statistically significant (P <0.05).1.1.2 The length, width, thickness and volume of thyroidThe length, width, thickness and volume of thyroid in subclinical hypothyroidism group and clinical hypothyroidism group compared with control group differences were statistically significant (P < 0.05), and compared with control group increased. The thickness of thyroid in subclinical hypothyroidism group compared with clinical hypothyroidism group was no significant difference (P > 0.05), the other differences were statistically significant (P <0.05).1.2 Characteristics of color Doppler ultrasound 1.2.1 The diameter of the superior thyroid arteryThe superior thyroid artery diameter was significantly among three groups(P<0.05), The diameter of the superior thyroid artery in subclinical hypothyroidism and clinical hypothyroidism group is wider than in the control group, difference between the subclinical hypothyroidism and clinical hypothyroidism group were statistically significant (P <0.05),clinical hypothyroidism group widened even more obvious.1.2.2 Thyroid blood flow characteristics within the organizationIn control group, blood flow signals within the thyroid tissue is not abundant, showing sparse distribution of points and fascicular blood flow signals. In subclinical hypothyroidism and clinical hypothyroidism group,there are increased blood flow signals within the thyroid gland, some patients full of color flow signals within the thyroid gland. The differences were statistically significant (P < 0.05), subclinical hypothyroidism group compared with clinical hypothyroidism group was no significant difference (P> 0.05).1.3 Spectral Doppler ultrasonography1.3.1 The superior thyroid artery systolic maximum velocity (Vmax)Subclinical hypothyroidism and clinical hypothyroidism group compare with control group,there was significant difference (P <0.05),, the superior thyroid artery systolic maximum velocity was increase than those in the control group,subclinical hypothyroidism group compared with Clinical hypothyroidism group was no significant difference ( P> 0.05).1.3.2 Resistance Index (RI)The resistance index of the superior thyroid artery was no significant difference among three groups (P>0.05).1.4 Spectral Doppler curvesThe control group was low-speed low resistance Doppler spectrum shape type. The velocity in Subclinical hypothyroidism and clinical hypothyroidism group was higher than the control group,but also were low-impedance-type spectrum, spectrum peaks was blunt, diastolic flow decreased more slowly and evenly.2 Related Research2.1 The correlation of the highest systolic velocity (Vmax)of the superior thyroid artery and the unilateral thyroid volume(V)The the highest systolic velocity and unilateral thyroid volume were positively correlated in subclinical hypothyroidism and clinical hypothyroidism group through to do linear correlation analysis, the correlation coefficient were as follows: 0.62, 0.71.2.2 The correlation of the diameter of superior thyroid artery and the thyroid stimulating hormone levelsThe diameter of superior thyroid artery and the thyroid stimulating hormone levels were positively correlated in subclinical hypothyroidism and clinical hypothyroidism group through to do linear correlation analysis, the correlation coefficient were as follows: 0.59,0.67.Conclusion:1 In patients with hypothyroidism(Course of disease in patients less than 3 months)the thyroid internal echo thickening, localized or diffuse echo reduction.Subclinical hypothyroidism in patients with diffuse thyroid gland to reduce the echo within the majority of those without a high echo belt,the majority of clinical hypothyroidism in patients with diffuse echo reduction and the formation of high-echo belt. Therefore, echo characteristics of the thyroid gland can be used as reference for the diagnosis of hypothyroidism.2 In patients with hypothyroidism(Course of disease in patients less than 3 months)the thyroid volume and each diameter lines were increased,more significantly increased in patients with clinical hypothyroidism, these indicators reflect the status of thyroid function may be the disease development and treatment evaluation.3 In patients with hypothyroidism (Course of disease in patients less than 3 months)the thyroid tissue may also occur the phenomenon of increased blood flow signal, it seems as“sea of fire levies”, broadening the superior thyroid artery diameter, flow rate increased, but the subclinical hypothyroidism and clinical hypothyroidism between the two groups had no significant difference, so thyroid blood flow characteristics within the organization still does not reflect the degree of hypothyroidism..4 In patients with hypothyroidism(Course of disease in patients less than 3 months)the highest systolic velocity of the superior thyroid artery and the unilateral thyroid volume were positively correlated.5 In patients with hypothyroidism(Course of disease in patients less than 3 months)the thyroid artery diameter and thyroid stimulating hormone level was positively correlated.更多还原