桥本甲状腺炎的超声与实验室检查的相关性研究

Correlation studies on ultrasonography and laboratory examination of Hashimoto thyroiditis

目的探讨桥本甲状腺炎的超声表现与血清甲状腺功能检查的相关性。方法观察超声检查及血清甲状腺功能检查均疑似为桥本甲状腺炎的患者200例,依据实验室检查结果分为抗体明显升高组[抗甲状腺过氧化物酶抗体(TPOAb)>1 300 IU/ml或抗甲状腺球蛋白抗体(TGAb)>500 IU/ml,110例]和抗体轻度升高组(TPOAb<1 300 IU/ml和TGAb<500 IU/ml,90例)。对照超声观察甲状腺实质回声类型及血流分布、超声测量腺体厚径,总结其声像图特征。结果抗体明显升高组与抗体轻度升高组,组内年龄分布无统计学差异(P=0.753),抗体明显升高组女性患者构成高于轻度升高组(P=0.007)。抗体明显升高组中TSH升高16例,抗体轻度升高组中TSH升高7例,两组间TSH升高的发生率无统计学差异(?2=2.228,P=0.136)。两组组内甲状腺左、右叶测值比较均无统计学意义(明显升高组P=0.443,轻度升高组P=0.276)。抗体明显升高组甲状腺峡部厚径明显大于抗体轻度升高组(P=0.003)。两组中均匀型、网格型、局灶型和结节型分布不同(?2=68.896,P<0.001)。相关性分析(Contingency Coefficient法)结果显示抗体升高水平与超声分型有关(P<0.001)。两组甲状腺癌变比率无统计学差异(P=0.615)。结论桥本甲状腺炎血清抗体增高的程度与甲状腺超声结构的改变有一定的相关性;血清抗体升高的程度可能与病变的范围或程度相关;抗体明显升高时甲状腺功能减退的发生率及结节癌变的概率是否增高目前无统计学结果支持。

Objective To explore the correlation between ultrasonography findings and serum thyroid function in Hashimoto thyroiditis. Methods 200 patients suspected of Hashimoto thyroiditis with the results of ultrasonography and serum thyroid function were divided into the antibody significantly increased group and the antibody slightly increased group, according to the serum antiperoxidase antibodies(thyroid peroxidases antibody, TPOAb>1 300 IU/ml or TGAb>500 IU/ml) and serum thyroglobulin antibody(thyroid globulin antibody, TPOAb<1 300 IU/ml and TGAb<500 IU/ml), then the thyroid parenchyma ultrasonography types, the distribution of blood flow in the background ultrasonic measurement glands and the thyroid width were valued by ultrasonography and the ultrasonographic manifestations were summarized. Results There were 110 cases in the antibody significantly increased group and 90 cases in the antibody slightly group, and there was no significant difference in the age distribution between the two groups(P=0.753). The antibody significantly increased group had more females(P=0.007). There was no significant difference in the incidence of elevated thyroid stimulating hormone(TSH) between the two groups(?2=2.228, P=0.136). Right lobe of the thyroid test values in both groups had no statistical significance respectively(P=0.443 and P=0.276). The thickness of the isthmus of thyroid was significantly higher in the antibody significantly increased group than in the antibody slightly increased group(P=0.003). The distribution of the ultrasonography types(uniform types, grid sample change, focal change, nodular lesions) in the two groups was significantly different(?2=68.896, P<0.001). Correlation analysis(Contingency Coefficient method) showed that the level of increased antibodies was associated with the ultrasonography types(P<0.001). The rate of thyroid cancer in both the groups had no statistical difference(P=0.615). Conclusions The level of increased antibodies was associated with ultrasonography structure of throid in Hashimoto thyroiditis and may be associated with the scope or degree of the lesions, but it was not enough to show the correlation of the level of increased antibodies and the incidence of hypothyroidism and the risk of nodule cancerization.