血清学与影像学联合检测在甲状腺功能亢进和妊娠合并Graves病鉴别诊断中的临床价值

Value analysis about the combined detection of serological and imaging in differentiating GHT and GDP

目的:分析甲状腺功能、甲状腺自身抗体、甲状腺彩超检查鉴别甲状腺功能亢进(GHT)和妊娠合并Graves病(GDP)的临床价值。方法:按病理分型不同将64例未经治疗的妊娠期甲状腺功能亢进患者分为GHT组与GDP组,每组各32例;选取同一阶段正常体检的32例妊娠期甲状腺功能正常者作为对照组1;32名非妊娠期甲状腺功能正常者为对照组2。比较各组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(STA-D)、甲状腺功能[三碘甲状原氨酸(T3)、甲状腺素(T4)、促甲状腺激素(TSH)]、甲状腺自身抗体[抗甲状腺球蛋白抗体(TG-Ab)、甲状腺过氧化物酶抗体(TPO-Ab)、促甲状腺受体抗体(TRAb)]。结果:GDP组STA-PSV水平均高于其他3组,GDP组STA-D水平均高于其他3组(P<0.05);GHT组中Ⅰ度肿大患者占37.50%(12/32),GDP组中Ⅰ度肿大患者占43.75%(14/32),两组间无统计学差异(P>0.05),但Ⅱ度肿大仅存在于GDP组患者,占40.63%(13/32),差异有统计学意义(P<0.05);GDP组患者T3、T4水平均高于其他3组,TSH水平低于其他3组,TRAb水平高于其他3组,差异均有统计学意义(P<0.05);GDP组TGA水平高于其他3组,GDP组TPO-Ab水平高于其他3组,差异均有统计学意义(P<0.05)。结论:针对GHT和GDP患者的鉴别诊断,仅依靠彩超的诊断有效性相对较低,可联合甲状腺功能及甲状腺自身抗体检查进行鉴别诊断,应用价值更高。

Objective:To analyze the application value of thyroid function,thyroid autoantibody and thyroid color Doppler ultrasonography in differentiating hyperthyroidism(GHT)and pregnancy complicated with Graves disease(GDP).Methods:64 patients with hyperthyroidism in pregnancy who were not treated were selected and divided into GHT group and GDP group,32 cases in each group.At the same time,32 patients with normal thyroid function in pregnancy who underwent physical examination at the same stage were selected as control group 1 and 32 non pregnant individuals with normal thyroid function served as control group 2.The systolic peak blood flow velocity(STA-PSV)and diastolic diameter(STA-D)of superior thyroid artery,thyroid function[triiodothyronine(T3),thyroxine(T4)and thyroid stimulating hormone(TSH)],thyroid autoantibodies[anti thyroglobulin antibody(TG-Ab),thyroid peroxidase antibody(TPO-Ab),thyroid stimulating receptor antibody(TRAb)]were compared between groups.Results:The levels of STA-PSV in GDP group was higher than that in GHT,control group 1 and control group 2.The levels of STA-D in GDP group was higher than that in GHT,control group 1 and control group 2(P<0.05).The patients with grade I swelling accounted for 37.50%(12/32)in GHT group and 43.75%(14/32)in GDP group,there was no significant difference between the groups(P>0.05).Grade II swelling only existed in GDP group,accounted for 40.63%(13/32),there was significant difference between the groups(P<0.05).The levels of T3 and T4 in GDP group were higher than those in the other three groups,the level of TSH was lower than those in the other three groups,and the level of TRAb was higher than those in the other three groups(P<0.05).The level of TGA in GDP group was higher than that in the other three groups,and the level of TPO-Ab in GDP group was higher than that in the other three groups(P<0.05).Conclusion:For the differential diagnosis of patients with GHT and GDP,the diagnostic effectiveness of only relying on color Doppler ultrasound is relatively low.It can be combined with thyroid function and thyroid autoantibody examination for differential diagnosis,which has higher application value.