甲状腺超声鉴别桥本甲状腺炎患者甲亢甲减的临床价值

Clinical value of thyroid ultrasound in identifying hyperthyroidism and hypothyroidism in patients with Hashimoto's thyroiditis

目的:探讨彩色超声在鉴别桥本甲状腺炎患者甲亢、甲减方面的临床价值。方法:回顾性分析北京市西城区平安医院2022年8月—2023年8月经临床确诊的150例桥本患者(桥本组)的病历资料,按照甲状腺功能水平将桥本组分为甲亢组(46例)、甲功正常组(52例)、甲减组(52例),同时选取健康体检患者60名作为正常对照组。分别对三组进行甲状腺彩色多普勒超声检查,经二维超声测量甲状腺的相关参数,观察甲状腺实质回声情况,经彩色多普勒超声观察实质内彩色血流信号分布情况,经频谱多普勒测量甲状腺上动脉流速、阻力指数、搏动指数、频谱加速度及加速时间,并对各组上述数据进行比较。结果:在甲状腺的相关参数方面,甲亢组、甲功正常组长径、宽径、厚径、峡部厚径均大于正常对照组(P<0.05),甲减组长径、宽径、厚径、峡部厚径均小于正常对照组(P<0.05)。桥本组甲状腺上动脉的阻力指数、搏动指数高于正常对照组,但组间差异无统计学意义(P>0.05);甲亢组、甲减组的频谱加速度、血流速度及甲减组的加速时间高于或长于甲功正常组及正常对照组(P<0.05);甲亢组的加速时间短于甲功正常组(P<0.05)。在血流分级方面,甲亢组以2、3级为主,甲减组以1、2级为主,甲功正常组以0、1级为主。结论:彩色超声在鉴别桥本甲状腺炎患者甲亢、甲减方面有重要的临床应用价值,可辅助临床判断甲状腺功能状态。

Objective To explore the clinical value of color ultrasound in distinguishing hyperthyroidism and hypothyroidism in patients with Hashimoto's thyroiditis.Methods A retrospective was conducted on 150 patients with Hashimoto's thyroiditis who were clinically diagnosed from August 2022 to August 2023.They were divided into three groups according to their thyroid function level:46 cases of hyperthyroidism group,52 cases of normal thyroid function group,and 52 cases of hypothyroidism group.At the same time,60 healthy patients were selected as the control group.Color Doppler ultrasonography was performed on each group to measure the size parameters of the thyroid gland,observe the echo condition of the thyroid parenchyma,observe the distribution of color flow signals in the thyroid parenchyma with color Doppler ultrasonography,and measure the flow velocity,resistance index,pulsatility index,spectral acceleration,and acceleration time of the thyroid artery with spectral Doppler.The differences between groups were compared to determine whether they were statistically significant.Results In terms of thyroid-related parameters,the length,width,thick diameter and isthmus thickness diameter in the hyperthyroid group and the normal thyroid function group were higher than the normal control group(P<0.05),and the length,width,thick diameter and isthmus thickness diameter in the hypothyroidism group were lower than the normal control group(P<0.05).The resistance index and pulsation index of the superior thyroid artery in Hashimoto's group were higher than those in the normal control group,but there was no significant difference between the groups(P>0.05).The spectral acceleration,blood flow velocity,and acceleration time of the hyperthyroidism and hypothyroidism groups were higher than those of the hypothyroidism group or longer than those in the normal thyroid function group and the normal control group(P<0.05),and the acceleration time in the hyperthyroid group was shorter than that in the normal thyroid function group(P<0.05).In terms of blood flow classification,grade 2 and 3 were the hyperthyroid group,grade 1 and 2 were the hypothyroid group,and grade 0 and 1 were the normal thyroid function group.Conclusion Color ultrasound has important clinical application value in distinguishing hyperthyroidism and hypothyroidism in patients with Hashimoto's thyroiditis,and can assist in clinical judgment of thyroid function status.