甲状腺上动脉峰值血流速度在自身免疫性甲状腺毒症鉴别中的应用  

Application of the superior thyroid artery peak systolic velocity in differentiating Graves′disease from autoimmune thyroiditis

作　　者：王晨 朱宇[1] 周灵丽[1] 赵赟赟[2] 韩学尧[1] 纪立农[1] Wang Chen;Zhu Yu;Zhou Lingli;Zhao Yunyun;Han Xueyao;Ji Linong(Department of Endocrinology and Metabolism,Peking University People's Hospital,Beijing 100044,China;Department of Nuclear Medicine,Peking University People's Hospital,Beijing 100044,China;Department of Endocrinology,Tangshan People's Hospital,Tangshan 063000,China)

机构地区：[1]北京大学人民医院内分泌科,100044 [2]北京大学人民医院核医学科,100044 [3]河北省唐山市工人医院内分泌科,063000

出　　处：《中华内科杂志》2020年第3期207-212,共6页Chinese Journal of Internal Medicine

摘　　要：目的探讨甲状腺上动脉峰值血流速度(STA-PSV)对自身免疫性甲状腺毒症病因鉴别诊断的临床应用价值。方法收集2015年1月至2018年10月北京大学人民医院内分泌科新诊断的未用抗甲状腺药物治疗的自身免疫性甲状腺毒症患者301例,其中Grave病(GD)患者241例,自身免疫性甲状腺炎(AIT)患者60例,比较两组患者STA-PSV、甲状腺功能、促甲状腺激素受体抗体(TRAb)等相关指标。通过多元线性回归分析影响STA-PSV的相关因素。通过受试者工作特征(ROC)曲线下面积(AUC)评价STA-PSV对GD的鉴别能力。结果GD组STA-PSV明显高于AIT组[61.00(41.00,86.50)cm/s比34.50(25.25,46.00)cm/s,P<0.001],ROC曲线分析,AUC为0.790(95%CI 0.734~0.845,P<0.001),当STA-PSV切点值≥49.5 cm/s时,诊断GD的敏感性为64.3%,特异性为83.3%。在所有甲状腺毒症患者中,以STA-PSV(对数转换后)为因变量,以游离甲状腺素(FT4)和TRAb为自变量进行多因素回归分析,结果显示STA-PSV与FT4(β=0.371,95%CI 0.005~0.010,P<0.001)和TRAb(β=0.138,95%CI 0.001~0.014,P=0.035)独立相关。结论STA-PSV对GD和AIT具有一定的鉴别诊断意义,且与甲状腺素水平和TRAb相关。Objective To evaluate the clinical value of the superior thyroid artery peak systolic velocity(STA-PSV)for the differential diagnosis of autoimmune thyrotoxicosis.Methods A total of 301 patients with newly diagnosed thyrotoxicosis and without any anti-thyroid drug intervention were collected from the Department of Endocrinology and Metabolism,Peking University People's Hospital from Jan.2015 to Oct.2018.Among them,241 patients were with Graves'disease(GD)and 60 patients were with autoimmune thyroiditis(AIT).STA-PSV,thyroid function and thyrotropin receptor antibody(TRAb)were determined.A multiple linear regression was used to identify factors associated with STA-PSV.A receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the discriminating ability of STA-PSV to GD.Results STA-PSV leves in GD group were significantly higher than those in AIT group[61.00(41.00,86.50)cm/s vs.34.50(25.25,46.00)cm/s,P<0.001].The ROC curve analysis showed that the AUC was 0.790(95%CI 0.734-0.845),and 49.5cm/s was the optimal cutoff point for the diagnosis of GD,in which the sensitivity was 64.3% and the specificity was 83.3%.In all patients with thyrotoxicosis,multiple linear regression analyses showed free thyroxine(FT4)(β=0.371,95%CI 0.005-0.010,P<0.001)and TRAb(β=0.138,95%CI 0.001-0.014,P=0.035)were positively associated with STA-PSV.Conclusions The STA-PSV is positively associated with FT4 and TRAb levels,and it is a helpful marker in differential diagnosis between GD and AIT.

关 键 词：格雷夫斯病 甲状腺炎 自身免疫性 甲状腺毒症 血流速度 

分 类 号：R5[医药卫生—内科学]