不同超声诊断亚急性甲状腺炎出现甲减期声像图特征及其危险因素分析

Ultrasonographic Characteristics and Risk Factors of Hypothyroidism in Subacute Thyroiditis Diagnosed by Different Ultrasonography

目的:探讨不同超声诊断亚急性甲状腺炎出现甲减期声像图特征及其危险因素。方法:收集2022年10月-2023年4月于我院就诊的亚急性甲状腺炎患者121例,行首次甲状腺超声检查并进行6个月的临床资料随访。用常规超声模式(二维、多普勒)对两侧叶甲状腺进行纵横断面扫查并进行记录,接着启动弹性成像模式进行扫查。对比亚急性甲状腺炎患者出现甲减期与未出现甲减期的一般临床资料及早期超声二维、多普勒、弹性声像图特征,使用单因素分析、多因素Logistic回归分析亚急性甲状腺炎患者出现甲减期的危险因素,ROC曲线分析病灶区弹性模量值、应变率、病变区甲状腺上动脉阻力指数及流速对亚急性甲状腺炎患者出现甲减期的预测价值。结果:121例亚急性甲状腺炎患者最终完成随访115例,其中出现甲减期者29例,未出现甲减期者86例,出现甲减期的占比为25.22(29/115)。经统计学分析,亚急性甲状腺炎患者出现甲减期与累及侧叶、病灶区甲状腺上动脉峰值流速及阻力指数有关(P>0.05)。亚急性甲状腺炎患者出现甲减期的弹性模量值、应变率明显较未出现甲减期患者高(P>0.05)。病灶区甲状腺上动脉峰值流速、阻力指数、病灶区弹性模量值和应变率对亚急性甲状腺炎患者出现甲减期预测ROC曲线结果表明,弹性模量值的AUC为0.898,约登指数0.770、敏感度82.8%、特异度94.2%,截断值114.5。应变率AUC为0.74,约登指数0.422、敏感度72.4%、特异度69.8%,截断值8.2。阻力指数AUC为0.760,约登指数0.562,敏感度65.5%,特异度90.7%,截断值0.66;甲状腺上动脉血流速度AUC为0.838,约登指数0.608,敏感度72.4%,特异度88.4%,截断值25.94。单因素分析结果表明,亚急性甲状腺炎出现甲减期与未出现甲减期患者的FT3、FT4、TRAb、ESR、hs-CRP对比有统计学意义(P<0.05)。Logistic回归分析结果表明,FT4、TRAb、ESR、hs-CRP升高是亚急性甲状腺炎出现甲减期的危险因素(P<0.05)。结论:二维超声、多普勒超声、弹性超声联合技术可早期预测亚急性甲状腺炎后甲状腺功能减退,亚急性甲状腺炎出现甲减期的危险因素为FT4、TRAb、ESR、hs-CRP水平升高。

Objective:To investigate the ultrasonographic characteristics and risk factors of hypothyroidism in subacute thyroiditis diagnosed by different ultrasonography.Methods:121 patients with subacute thyroiditis who were treated in our hospital from October2022 to April 2023 were enrolled for the first thyroid ultrasound examination and clinical data were followed up for 6 months.The longitudinal and transverse section of the bilateral lobar thyroid gland was examined and recorded by conventional ultrasound mode(2D,Doppler),and then the elastic imaging mode was activated for scanning.The general clinical data of subacute thyroiditis patients with hypothyroidism and those without hypothyroidism were compared,and the early ultrasonographic characteristics of two-dimensional,Doppler and elastic ultrasonography were compared.Univariate analysis and multivariate Logistic regression were used to analyze the risk factors of hypothyroidism in subacute thyroiditis patients.ROC curve was used to analyze the value of elastic modulus,strain rate,superior thyroid artery resistance index and velocity in predicting hypothyroidism in patients with subacute thyroiditis.Results:121patients with subacute thyroiditis were followed up in 115 cases,of which 29 had hypothyroidism and 86 had no hypothyroidism.The proportion of hypothyroidism was 25.22(29/115).According to statistical analysis,the period of hypothyroidism in subacute thyroiditis patients was related to the peak velocity and resistance index of the superior thyroid artery involved in the lateral lobe and focal area(P>0.05).The elastic modulus and strain rate of subacute thyroiditis patients with hypothyroidism were significantly higher than those without hypothyroidism(P>0.05).ROC curves of peak velocity,resistance index,elastic modulus and strain rate of thyroid artery in focal area for hypothyroidism in subacute thyroiditis patients showed that the AUC of elastic modulus was 0.898,the approximate exponent was 0.770,the sensitivity was 82.8%,the specificity was 94.2%,and the cut-off value was 114.5.The strain rate AUC was 0.74,the Jorden index was 0.422,the sensitivity was 72.4%,the specificity was 69.8%,and the cutoff value was 8.2.The resistance index AUC was0.76,the Yoden index was 0.562,the sensitivity was 65.5%,the specificity was 90.7%,and the cut-off value was 0.66.The flow velocity AUC of superior thyroid artery was 0.838,the Yoden index was 0.608,the sensitivity was 72.4%,the specificity was 88.4%,and the truncation value was 25.94.The results of univariate analysis showed that the comparison of FT3,FT4,TRAb,ESR and hs-CRP between subacute thyroiditis and no thyroiditis showed statistical significance(P<0.05).The results of Logistic regression analysis indicated that elevated FT4,TRAb,ESR,and hs-CRP were risk factors for hypothyroidism in subacute thyroiditis(P<0.05).Conclusion:The combination of two-dimensional ultrasound,Doppler ultrasound and elastic ultrasound can predict hypothyroidism early after subacute thyroiditis.The risk factors for hypothyroidism in subacute thyroiditis are levels increased of FT4,TRAb,ESR and hs-CRP.