探讨彩色多普勒超声与甲状腺自身抗体和激素联合检测在Graves病诊断、治疗过程中的临床应用价值

Clinical Significance of Color Doppler Imaging Combined with Thyroid Hormone and Autoantibody Test for the Diagnosing and Treatment of Graves Disease

观察Graves病患者治疗前后的血流特征及甲状腺上动脉的舒张期内径变化情况,分析彩色多普勒超声与甲状腺自身抗体和激素联合检测在Graves病诊断、治疗过程中的临床意义。选择2011年2月至2014年1月在该院接受治疗的Graves病患者143例,在治疗前和治疗6、12和24个月,分别采用分辨免疫荧光法测定血清FT3、FT4、TT3、TT4、TSH,采用免疫放射分析法测定自身抗体TRAb、TGAb、TMAb,采用化学发光法测定自身抗体TPOAb,采用彩色多普勒血流显像仪测定甲状腺上动脉的收缩期峰值血流速度(PSV)和舒张期内径(D)。治疗6~12个月后,92例缓解患者的甲状腺激素FT3、FT4、TT3、TT4、TSH降至正常范围,但仍有一部分缓解患者的血清TRAb、TGAb、TMAb、TPOAb未恢复到正常范围。患者TT3、TT4、TSH平均水平在6个月恢复正常,FT3、FT4、TGAb、TMAb、D平均水平在12个月恢复正常,PSV、TPOAb、TRAb平均水平在24个月恢复正常。治疗6、12和24个月的甲状腺激素FT3、FT4、TT3、TT4平均水平与自身抗体TRAb、TGAb、TMAb平均水平均明显低于治疗前(P<0.01或P<0.05),TSH平均水平显著高于治疗前(P<0.01)。治疗12和24个月的D、PSV、自身抗体TPOAb平均水平明显低于治疗前水平(P<0.01)。将彩色多普勒超声检查、血清甲状腺激素水平及甲状腺自身抗体的检测联合起来能准确把握和了解Graves病治疗效果动态变化的过程与规律,对于提高Graves病诊断和治疗效果具有重要的临床价值。

The blood flow characteristics and the changes of the diastolic diameter of the superior thyroid artery were observed before and after the treatment of Graves＇ s disease,to analyze the significance of color Doppler imaging combined with thyroid hormone and autoantibody test for the diagnosis and treatment of Graves disease. 143 Graves disease patients who accepted treatment from Feb2011 to Jun 2014 were selected and their serum FT3,FT4,TT3,TT4 and TSH were measured by resolution immunofluorescence before and 6,12 and 24 months after treatment. Radioimmunoassay was taken to detect autoantibody TRAb,TGAb,TMAb and chemiluminescence method was taken to detect autoantibody TPOAb. The diastolic inner diameter（ D） and peak systolic velocity（ PSV）of the superior thyroid artery in Graves disease patients were measured by color Doppler test. 6 ~ 12 months after treatment,the thyroid hormones FT3,FT4,TT3,TT4,TSH of 92 remission Graves disease patients had returned to the normal levels,but there were still some remission patients＇ serum TRAb,TGAb,TMAb,and TPOAb were not restored to normal range. The average level of TT3,TT4,TSH recovered to normal after 6 months treatment,the average levels of FT3,FT4,TGAb,TMAb and D recovered in12 months,and the average level of PSV,TPOAb and TRAb returned to normal in 24 months. The mean levels of thyroid hormones FT3,FT4,TT3 and TT4,autoantibodies TRAb,TGAb,TMAb were significantly lower than those before treatment（ P〈 0. 01 or P〈 0. 05）,and the average level of TSH was significantly higher than that before treatment（ P〈 0. 01） in 6,12 and 24 months of treatment. The average level of D,PSV and autoantibody TPOAb for 12 and 24 months of treatment was significantly lower than that before treatment（ P〈 0. 01）. Combining color Doppler ultrasonography,serum thyroid hormone level and thyroid autoantibody detection can accurately grasp and understand the process and rule of dynamic change of Graves disease treatment effect. It has important clinical value to improve the diagnosis and treatment effect of Graves＇ s disease.