甲状腺激素联合磁共振弥散加权成像评价复发-缓解型多发性硬化临床病程的价值

The value of thyroid hormone combined with diffusion-weighted imaging in the evaluation of relapsing-remitting multiple sclerosis

目的:探讨甲状腺激素测定联合磁共振弥散加权成像在评价复发-缓解型多发性硬化(MS)患者病情中的价值。方法:回顾性分析经临床确诊的复发-缓解型MS患者的临床资料,分为急性发作组和缓解组,另纳入健康体检者作为对照组。分析各组间TSH、fT_3、T_3、fT_4、T_4和甲状腺自身抗体(ATA)间的差异,同时分析急性发作组和缓解组总的MS、DWI高信号病灶间的差异,并分析DWI高信号病灶负荷与甲状腺激素间的相关性。结果:51例复发-缓解型MS患者共发现757个MS病灶,急性发作组和缓解组间年龄、性别及总MS病灶数差异无统计学意义。急性发作组患者病程要短于缓解组(P=0.003)。急性发作组患者fT_3、T_3、TSH水平均低于缓解组和对照组(P<0.05),急性发作组患者fT_4水平低于对照组(P=0.015),而相对于缓解组有降低趋势(P=0.072)。缓解组患者TSH水平相对于对照组有降低趋势(P=0.091)。急性发作组患者ATA阳性率高于对照组(P=0.044),缓解组ATA阳性率较对照组有增高趋势(P=0.09)。急性发作组患者出现DWI阳性病灶的比例高于缓解组(P=0.002)。急性发作组患者DWI阳性病灶负荷大于缓解组(P=0.001)。DWI阳性病灶负荷与fT_3负相关(r=-0.332,P=0.097)。结论:甲状腺激素联合DWI有助于临床评价复发-缓解型MS病程。

Objective:To explore the value of thyroid hormone combined with diffusion-weighted imaging in the evaluation of relapsing-remitting MS(RRMS).Methods:The clinical data of relapsing-remitting MS were retrospectively analyzed.The relapsing-remitting MS patients were divided into acute attack group and remission group according to the clinical courses.And health examination cases were enrolled as the control group.The difference in TSH,fT 3,T 3,fT 4,T 4,and ATA among the three groups was analyzed.The differences in the total MS lesions and DWI hyperintensity lesions between acute attack group and remission group were also analyzed.The relationship between thyroid hormone and the burden of DWI hyperintensity lesion was analyzed.Results:A total of 51 RRMS patients with 757 MS lesions were found in the final analysis.No difference was found in age,sex,and the total MS lesions among the three groups.The clinical course time in the acute attack group was shorter than that in the remission group(P=0.003).The levels of fT 3,T 3,and TSH in the acute attack group were all lower than those in the remission group and control group(P<0.05).The level of fT 4 in the acute attack group were all lower than that in the control group(P=0.015)and had a decreasing trend compared with the remission group(P=0.072).The level of TSH in the remission group had a decreasing trend compared with the control group(P=0.091).The positive rate of ATA in the acute attack group was higher than that in the control group(P=0.044).The positive rate of ATA in the remission group had an increasing trend compared with the control group(P=0.09).There were more patients with DWI hyperintensity lesions in the acute attack group than those in the remission group(P=0.002).The burden of DWI hyperintensity lesion in the acute attack group was more serious than that in the remission group(P=0.001).The burden of DWI hyperintensity lesion had a trend to negatively correlate with the level of fT 3(r=-0.332,P=0.097).Conclusions:Thyroid hormone and DWI is helpful to evaluate the clinical course of relapsing remission MS.