剪切波弹性成像评估甲巯咪唑治疗初诊Graves病疗效的应用价值

Evaluation of the efficacy of methimazole in the treatment of newly diagnosed Graves′disease by shear wave elastography

目的 探讨超声剪切波弹性成像(shear wave elastography, SWE)技术评估甲巯咪唑治疗初诊Graves病疗效的临床应用价值。方法 收集60例经滨州医学院附属医院初诊确诊为Graves病的患者,给予服用甲巯咪唑进行治疗,检测治疗前及治疗2月后患者血清甲状腺功能指标包括血清促甲状腺激素(thyrotropin, TSH)、血清游离三碘甲状腺原氨酸(free triiodothyronine, FT3)和血清游离甲状腺素(free thyroxine, FT4),以及甲状腺自身免疫性炎症指标促甲状腺激素受体抗体(TRAb)。同时应用SWE技术分别测量患者治疗前及治疗2月后甲状腺组织的杨氏模量最大值、最小值和平均值,应用配对t检验对治疗前后的结果进行分析比较。结果 比较治疗前及治疗2月后结果显示,所测血清甲状腺功能指标(TSH、FT3、FT4)显著改善(P<0.01),TRAb显著好转(P<0.05);应用SWE技术测得患者甲状腺组织的各项杨氏模量值也有显著变化(P<0.01)。结论 SWE技术测得甲状腺组织杨氏模量值的变化与患者甲状腺功能指标变化的临床意义一致,说明SWE实时、定量且客观获取的患者甲状腺组织的硬度变化信息,可为临床医师准确评估Graves病治疗效果及调整用药剂量提供重要的量化参考依据,具有较高的临床应用价值。

Objective To investigate the clinical value of ultrasonic shear wave elastography(SWE)in evaluating the efficacy of methimazole in the treatment of newly diagnosed Graves′disease.Methods A total of 60 patients with Graves′disease who were newly diagnosed by Binzhou Medical University Hospital were treated with methimazole.Serum thyroid function indicators,including serum thyrotropin(TSH),serum free triiodothyronine(FT3),serum free thyroxine(FT4),and thyroid autoimmune inflammatory indicators of thyrotropin receptor antibody(TRAb)were detected before the treatment and 2 months after the treatment.At the same time,SWE technique was used to measure the maximum,minimum and average values of Young′s modulus of thyroid tissue before the treatment and 2 months after the treatment,and paired t-test was used to analyze and compare the results before and after the treatment.Results By comparing the results before the treatment and 2 months after the treatment,the serum thyroid function indexes(TSH,FT3,and FT4)were significantly improved(P<0.01).TRAb was significantly improved with statistical significance(P<0.05).At the same time,the Young′s modulus values of thyroid tissue were also significantly changed by SWE technique(P<0.01).Conclusion The changes of Young′s modulus of thyroid tissue measured by SWE technology are consistent with the clinical significance of the changes of thyroid function indexes in patients,indicating that SWE can obtain real-time,quantitative and objective information about hardness changes in patient thyroid tissues,so it can provide an important quantitative reference for clinicians to accurately evaluate the therapeutic effect of Graves′disease and adjust drug dosage,and has high clinical application value.