瞬时波强参数评价甲状腺功能亢进患者^131I治疗前后颈动脉血流动力学变化

Assessment of the hemodynamic changes before and after ^131 I therapy in hyperthyroid patients by wave intensity parameters

目的探讨瞬时波强（waveintensity，WI）参数评价甲状腺功能亢进（甲亢）患者^131I治疗前后颈动脉血流动力学变化的应用价值。方法47例甲亢患者作为甲亢组，47例健康志愿者作为对照组，均行颈总动脉WI检查，测量WI曲线两个正向峰的高度（W1、W2）及负向峰面积（NA），并计算NA的平方根值（A）。甲亢组中25例接受^131I治疗者作为治疗组，于治疗后3个月随访测量上述参数，比较治疗前、后各参数的变化。分析上述WI参数与甲状腺功能指标的相关性。随机抽取甲亢组和对照组受检者各10名，由同一检查者对WI各参数连续测量两次，检验WI测量重复性。结果①独立样本t检验显示：甲亢组较对照组W1、W2、A升高，差异有统计学意义（P=0．000；P=0．000；P=0．000）。②配对t检验显示：治疗组患者^131I治疗后较治疗前W1、A降低，差异有统计学意义（P=0．001；P=0．011）。③相关分析显示：甲亢组A与FT3正相关（r=0．508，P=0．003）；治疗组治疗后W1与FT3、FT4正相关（r=0．601，P=0．002；r=0．680，P=0．000），W2与FT3、FT4正相关（r=0．549，P=0．005；r=0．570，P=0．004）。④同一检查者连续测量WI参数W1、W2、NA、A，重复性尚好。结论甲亢患者颈总动脉WI检测峰值参数较正常人增高，部分敏感参数治疗后降低。WI检测对^131I治疗疗效评估提供了依据。

Objective To explore the value of wave intensity （WI） parameters in evaluating hemodynamic changes of cardiovascular system before and after ^131 I therapy in hyperthyroid patients. Methods Forty-seven hyperthyroid patients were enrolled as hyperthyroid group, while 47 healthy volunteers were considered as control group. Both of the hyperthyroid and control group took WI examinations,and WI curves of their right common carotid arteries were recorded. WI parameters of WI curve were automatically measured as followed： value of the first positive peak （W1）, value of the second positive peak （W2） ,area of the negative peak （NA） ,and the square root of NA （A）. Twenty-five patients of the hyperthyroid group received ^131I therapy were enrolled as treatment group. All these patients were followed up for 3 months. The repeatability of the WI parameters was evaluated in 10 hyperthyroid patients and 10 normal volunteers selected at random from the investigation. Results W1, W2, A in hyperthyroid group increased compared with those in control group, and independent-samples t test showed very significant difference （ P = 0. 000, P = 0. 000, P = 0. 000）. W1, A decreased after^131I therapy compared with those before treatment, and paired-samples t test showed significant difference （Wl ： P = 0. 001 ） A ： P = 0. 011）. A in hyperthyroid group had positive correlation with FT3 （ r = 0. 508, P = 0. 003）;Wl after ^131I therapy in treatment group had positive correlation with FT3 and FT4 （ r = 0. 601, P = 0. 002; r = 0. 680, P = 0.00） ~W2 after ^131I therapy in treatment group had positive correlation with FT3 and FT4 （ r = 0. 549, P = 0. 005; r = 0. 570, P = 0. 004）. The repeatability of W1, W2, NA and A were good by consecutive measurement of identical observer. Conclusions WI peak parameters of hyperthyroid patients were higher than those of healthy volunteers,and some sensitive parameters were decreased after ^131I therapy, which may provide the basis for assessing the effectiveness of ^131I therapy.