彩色多普勒超声、甲状腺功能及甲状腺自身抗体检查在鉴别妊娠甲状腺功能亢进和Graves病中的价值

The role of color doppler ultrasonography, thyroid function and auto antibody for the screening of Graves＆#39; disease in pregnancy

目的 探讨用甲状腺彩色多普勒超声、甲状腺功能、甲状腺自身抗体检查鉴别妊娠甲状腺功能亢进（GHT）和妊娠合并Graves病（GDP）的价值.方法 本研究为观察性研究,共入选未经治疗的妊娠期甲状腺毒症患者68例,包括GHT患者33例（GHT组）、GDP 35例（GDP组）.选择妊娠甲状腺功能正常者32例（C1组）和非妊娠甲状腺功能正常者30例（C2组）作为对照组.使用彩色多普勒超声测定甲状腺上动脉收缩期峰值血流速度（STA-PSV）、甲状腺上动脉舒张期内径并测定甲状腺功能及甲状腺自身抗体,用ROC曲线评价STA-PSV、甲状腺上动脉舒张期内径及甲状腺功能、甲状腺自身抗体鉴别诊断GDP和GHT的价值.同时记录病史、体征、人绒毛膜促性腺素（HCG）水平.结果 STA-PSV、甲状腺上动脉舒张期内径、促甲状腺激素（TSH）、游离甲状腺素（FT4）鉴别GHT和GDP的ROC曲线下面积分别为0.905、0.887、0.803、0.786;ROC曲线中最佳切点分别为40 cm/s、2.0mm,0.03 mIU/L、30 pmol/L,均具有较高的敏感度和特异度,分别为82.9％和81.8％、72.1％和87.9％ 、81.8％和75.2％、76.2％和80.3％.结论 彩色多普勒超声测定STA-PSV、甲状腺上动脉舒张期内径及甲状腺功能测定对GHT和GDP的鉴别诊断有帮助.

Objective To determine whether color doppler ultrasonography （CDU）,thyroid function or thyroid autoimmune antibodies could identify Graves＆#39; disease in pregnancy（GDP） in pregnant patients with newly diagnosed thyrotoxicosis.Methods It is an observational study.Sixty-eight pregnant patients with newly diagnosed thyrotoxicosis including gestational hyperthyroidism （GHT） subjects （GHT group,n =33） and GDP subjects （GDP group,n =35）,and 62 age-and sex-matched healthy subjects （C1 group：pregnant,n =32,C2 group：non-pregnant,n =30） were recruited.Thyroid function,human chorionic gonadotropin（HCG）,thyroid autoimmune antibodies were detected.Peak systolic velocity of the superior thyroid artery （STA-PSV） and diastole inner diameter（STA-D） of the superior thyroid artery were measured by CDU.A ROC curve was used to evaluate STA-PSV,STA-D,thyroid function and thyroid autoimmune antibodies for identification of GDP.Results The area under the ROC curve of STA-PSV,STA-D and thyroid stimulating hormone （TSH）,free T4 （FT4） for GDP were 0.905,0.887,0.803 and 0.786,respectively.The optimal cut-off points of STA-PSV,STA-D,TSH and FT4 for GDP were 40 cm/s,2.0mm,0.03 mIU/L and 30 pmol/L with the sensitivity of 82.9%,72.1%,81.8%,76.2% and specificity of 81.8%,87.9%,75.2%,80.3%,respectively.Conclusions Detection of STA-PSV and STA-D by CDU,as well as thyroid function,is useful in screening GDP in pregnant patients with thyrotoxicosis.