不同类型甲状腺上动脉PSV对Graves病与桥本氏甲状腺炎鉴别诊断的价值

Differential diagnosis of Graves′ disease and Hashimoto′s thyroiditis by different types peak systolic velocity of the superior thyroid artery

目的探讨不同类型甲状腺上动脉收缩期峰值流速(PSV),包括PSVleft、PSVright、PSVmax、PSVmin和PSVmean对Graves病与桥本氏甲状腺炎鉴别诊断的价值。方法收集Graves病患者(GD组)19例,桥本氏甲状腺炎患者(HT组)18例,另有正常对照组(N组)20例,所有患者及正常人均进行二维超声及彩色多普勒超声检查,测量双侧甲状腺上动脉PSV,并计算双侧平均PSV。采用ROC曲线判断不同类型PSV鉴别GD与HT的灵敏性和特异性。结果GD组、HT组和N组两两之间PSVleft、PSVright、PSVmax、PSVmin、PSVmean均有明显差异(P<0.01)。PSVmean与PSVmaxROC曲线下面积大于0.9,二者诊断界点分别为71cm/s与85cm/s,PSVmean和PSVmax对GD和HT鉴别诊断的灵敏度与特异度分别为94.7%、83.3%、89.5%、88.9%。结论不同类型甲状腺上动脉PSV对GD与HT鉴别诊断的价值不同,PSVmax与PSVmean具有较高的应用价值。当所测量的第一侧PSV大于85 cm/s时,可不必测量对侧PSV,但所测第一侧的PSV小于85 cm/s时,则应测量对侧PSV,进行综合诊断。

Objective To explore the values of peak systolic velocity （PSV） （PSV left, PSV right, PSV max, PSV rain, and PSV meun）of the superior thyroid artery in differential diagnosis of Graves＇ disease （GD） and Hashimoto thyroiditis （HT）. Methods 19 patients with GD, 18 patients with HT and 20 normal people were subjected to 2D and color Doppler ultrasound examination to obtain PSW of bilateral superior thyroid arteries and conclude the mean PSV of the two sides. Sensitivities and specificities of different types PSV in differential diagnosis of GD and HT were analyzed using ROC curves. Results There were statistic differences between any two groups in the value of PSVleft, PSVright, PSVmax, PSVmin and PSVmean, but only the area under the curve of PSVmean and PSVmax was more than 0.9. Their cut-off points were 71 cm/s and 85 cm/s, and sensitivities and specificities were as follows： PSVmean：94.7%, 83.3% ; PSVmax：89.5%, 88.9%. Conclusions PSVmax and PSVmean have high diagnostic accuracies. We can only measure one side PSV value when the first side is over 85 cm/s and must measure both when the first side is below 85 cm/s.