彩色多普勒超声在Graves病患者^(131)Ⅰ治疗中的价值

Diagnostic Value of Color Doppler Ultrasonography in Ⅰ-131 Treatment of Graves' Disease

目的观察Graves病患者131Ⅰ治疗前后的甲状腺体积及血流动力学的变化,评价彩色多普勒超声检查在Graves病131Ⅰ治疗中的临床价值。方法对52例行131Ⅰ治疗并临床治愈的Graves病患者在治疗前1d及治疗后6个月均行甲状腺彩色多普勒超声检查。二维超声测量52例患者131Ⅰ治疗前后的甲状腺大小,计算甲状腺体积;彩色多普勒超声观察52例患者131I治疗前后的甲状腺内部血流分布情况,测量甲状腺上动脉的内径及收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)。结果与治疗前比较,52例患者治疗后甲状腺体积缩小,甲状腺上动脉内径变窄,PSV、EDV降低,RI增高,差异均有统计学意义[(15.36±6.69)cm3、(0.22±0.05)cm,(123.00±37.60)、(59.10±18.70)cm.s-1,0.49±0.09vs(11.98±6.52)cm3、(0.19±0.08)cm,(64.70±24.60)、(26.40±11.60)cm.s-1,0.64±0.13,P<0.05或P<0.01)]。52例患者中,治疗前甲状腺血流分级为Ⅰ级、Ⅱ级所占比例均明显低于治疗后,差异均有统计学意义(1.92%、17.31%vs 59.62%、26.92%,P<0.05或P<0.01);治疗前甲状腺血流分级为Ⅲ级所占比例明显高于治疗后,差异有统计学意义(80.77%vs 13.46%,P<0.01)。结论 Graves病患者在131Ⅰ治疗前后行彩色多普勒超声检测甲状腺体积及血流动力学的变化,对Graves病诊断和治疗具有重要的临床价值。

Objective To observe the changes in thyroid volume and haemodynamics before and after Ⅰ-131 treatment of Graves＇ disease（GD）,and to evaluate the diagnostic value of color Doppler ultrasonography in GD.Methods Thyroid volume was measured by two-dimensional ultrasonography in 52 patients with GD who had been clinically cured with Ⅰ-131 at 1 day before treatment and 6 months after treatment.Furthermore,inner diameter of superior thyroid artery,peak systolic velocity（PSV）,end-diastolic velocity（EDV） and resistance index（RI） were determined by color Doppler ultrasonography.Results Compared with values before treatment,I-131 treatment induced significant increase in RI（0.64±0.13 vs 0.49±0.09,P0.05）,but obvious decrease in thyroid volume,inner diameter of superior thyroid artery,PSV and EDV[（11.98±6.52）cm3,（0.19±0.08）cm,（64.7±24.6）cm·s-1 and（26.4±11.6）cm·s-1vs（15.36±6.69）cm3,（0.22±0.05）cm,（123±37.6）cm·s-1 and（59.1±18.7）cm·s-1,respectively;P0.05 or P0.01）].Moreover,the proportions of patients with blood flow grade Ⅰ and Ⅱ before treatment were significantly lower than those after treatment（1.92% and 17.31% vs 59.62% and 26.92%,respectively;P0.05 or P0.01）,but the proportion of patients with blood flow grade Ⅲ before treatment was markedly higher than that after treatment（80.77% vs 13.46%,P0.01）.Conclusion The determination of thyroid volume and hemodynamics with color Doppler ultrasonography before and after Ⅰ-131 treatment has important clinical values for the diagnosis and treatment of GD.