剪切波弹性成像与甲状腺激素在妊娠期不同直径甲状腺恶性结节患者中的研究

Study of shear wave elastography and thyroid hormone in pregnant patients with malignant thyroid nodules of different diameters

目的探究剪切波弹性成像(shear wave elastography,SWE)与血清甲状腺激素在妊娠期不同直径甲状腺恶性结节患者中的应用价值。方法选取2019年6月至2021年6月于义乌市中心医院就诊的妊娠期甲状腺结节患者为研究对象,根据穿刺活检或手术切除后病理结果,将其分为恶性组(n=75)和良性组(n=75)。比较两组患者及恶性组不同直径大小患者的弹性模量最大值(E_(max))、弹性模量最小值(E_(min))、弹性模量平均值(E_(mean))、促甲状腺激素(thyroid-stimulating hormone,TSH)、游离三碘甲腺原氨酸(free triiodothyronine,FT_(3))、游离甲状腺素(free thyroxine,FT_(4))水平。采用Spearman相关系数模型分析SWE参数与甲状腺激素水平的相关性,采用受试者操作特征曲线分析SWE参数对妊娠期甲状腺恶性结节的诊断价值。结果恶性组患者的E_(max)、E_(min)、E_(mean)均显著大于良性组,TSH、FT_(3)和FT_(4)均显著低于良性组(P<0.05);恶性组结节直径>10mm患者的E_(max)、E_(min)和E_(mean)均显著大于结节直径≤10mm患者,TSH、FT_(3)和FT_(4)均显著低于结节直径≤10mm患者(P<0.05)。Spearman相关性分析显示,E_(max)、E_(min)、E_(mean)与TSH、FT_(3)、FT_(4)均呈负相关(P<0.05)。E_(max)、E_(min)、E_(mean)单独诊断相比,三项联合对妊娠期甲状腺恶性结节的诊断价值最高,曲线下面积为0.855,敏感度和特异性分别为93.00%和71.58%。结论妊娠期甲状腺恶性结节患者的SWE参数与甲状腺激素水平呈负相关,不同直径的甲状腺恶性结节患者SWE参数和甲状腺激素存在差异,SWE多项参数联合对妊娠期甲状腺恶性结节的诊断价值较高。

Objective To study shear wave elastography(SWE)and serum thyroid hormone in pregnant patients with malignant thyroid nodules of different diameters.Methods Pregnant patients with thyroid nodule who were admitted to Yiwu Central Hospital from June 2019 to June 2021 were selected as the research objects.According to the pathological results after puncture biopsy or surgical resection,they were divided into malignant group(n=75)and benign group(n=75).The maximum elastic modulus(E_(max)),minimum elastic modulus(E_(min)),mean elastic modulus(E_(mean)),thyroid-stimulating hormone(TSH),free triiodothyronine(FT_(3))and free thyroxine(FT_(4))were compared between the two groups and patients with different diameter nodules in malignant group.Spearman correlation coefficient model was used to analyze the correlation between SWE parameters and thyroid hormone levels.Receiver operating characteristic curve was used to analyze the diagnostic value of SWE parameters for thyroid malignant nodules during pregnancy.Results The E_(max),E_(min) and E_(mean) in malignant group were significantly higher than those in benign group,while TSH,FT_(3) and FT_(4) levels were significantly lower than those in benign group(P<0.05).In malignant group,E_(max),E_(min) and E_(mean) of patients with nodule diameter>10mm were significantly higher than those of patients with nodule diameter≤10mm,while TSH,FT_(3) and FT_(4) were significantly lower than those of patients with nodule diameter≤10mm(P<0.05).Spearman correlation analysis showed that E_(max),E_(min) and E_(mean) were negatively correlated with TSH,FT_(3) and FT_(4)(P<0.05).Compared with E_(max),E_(min) and E_(mean) alone,the three combinations had the highest diagnostic value for thyroid malignant nodules during pregnancy,with an area under the curve of 0.855,sensitivity and specificity of 93.00%and 71.58%,respectively.Conclusion SWE parameters in pregnant patients with thyroid malignant nodules are negatively correlated with thyroid hormone levels,and there are differences in SWE parameters and thyroid hormone in patients with thyroid malignant nodules of different diameters.The combination of SWE multiple parameters has high diagnostic value for thyroid malignant nodules during pregnancy.