桥本甲状腺炎增龄性改变的超声评估及其诊断价值研究  

The assessment of ultrasound on aging changes in Hashimoto′s thyroiditis and its diagnostic value

作　　者：解婷婷 李宁 唐姗 冯蕾[2] 马子龙 殷彤 张树华 JIE Tingting;LI Ning;TANG Shan;FENG Lei;MA Zilong;YIN Tong;ZHANG Shuhua(Department of Ultra-sound,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China;不详)

机构地区：[1]华北理工大学附属医院超声科,河北唐山063000 [2]解放军总医院第四医学中心,北京100048

出　　处：《实用医学杂志》2022年第21期2732-2738,2744,共8页The Journal of Practical Medicine

基　　金：河北省医学科学研究课题计划(编号:20210629,20221536)。

摘　　要：目的应用常规超声及剪切波弹性成像(SWE)评估不同年龄段桥本甲状腺炎(HT)患者超声指标的变化,并确立超声诊断指标及界值。方法选取华北理工大学附属医院经临床确诊的HT患者147例为HT组,124名健康者为对照组,均按年龄分为21~35岁亚组(HT组47例、对照组40例)、36~50岁亚组(HT组53例、对照组43例)、51~65岁亚组(HT组47例、对照组41例)。接受超声检查并记录:甲状腺体积(TV)、峡部厚度、上动脉收缩期峰值流速(PSV)、回声分级、血流分级、杨氏模量值(SWE_(mean))及剪切波速度值(SWV_(mean))。(1)分别比较HT患者、对照者不同年龄段超声参数的差异,并分析其与年龄的相关性;(2)比较HT患者与对照者超声参数的差异(总体及不同年龄段);(3)应用ROC曲线寻找不同年龄段HT超声诊断指标及界值。结果(1)不同年龄段HT组患者甲状腺回声分级、SWE_(mean)、SWV_(mean)差异有统计学意义(P<0.05),对照组SWE_(mean)、SWV_(mean)差异有统计学意义(P<0.05);HT组及对照组年龄均与SWE_(mean)、SWV_(mean)呈正相关(r=0.231、0.236,r=0.476、0.408;P<0.05)。(2)总体及不同年龄段HT患者TV、峡部厚度、PSV、回声分级、血流分级、SWE_(mean)、SWV_(mean)均大于对照者(P<0.05);(3)ROC显示:21~35岁、36~50岁及51~65岁人群中均为SWE_(mean)诊断HT的AUC值最高,截断值分别为13.53、13.78、15.96 kpa时,灵敏度、特异度均较高,分别为95.7%、80.5%,96.2%、89.4%,89.4%、62.5%。结论应用常规超声及SWE可以客观评价不同年龄段HT患者甲状腺的变化,且其甲状腺回声随年龄增加而减低,弹性随着年龄增加而增加;SWE_(mean)可作为21~35岁、36~50岁、51~65岁HT患者的最佳超声诊断指标,诊断界值分别为13.53、13.78、15.96 kpa。Objective To assess the changes in ultrasonic indexes in Hashimoto′s thyroiditis patients of different ages,and to determine the ultrasonic diagnostic indices and threshold value by using conventional ultra⁃sound and shear wave elastography(SWE).Methods A total of 147 patients with clinically diagnosed HT in our hospital were selected as a HT group,while 124 healthy people were selected as a control group.Both groups were divided into subgroups of ages 21~35(47,40 cases),36~50(53,43 cases)and 51~65(47,41 cases).All the patients underwent ultrasonography.Thyroid volume(TV),isthmus thickness,peak systolic velocity(PSV)of superior thyroid artery,echo grade,blood flow grade,SWE_(mean) and SWV_(mean) were recorded.The differences of ultrasonic parameters in different age groups of HT patients and controls were compared,and the correlation between ultrasound parameters and age were analyzed.Ultrasonic parameters between HT and controls(overall and in different age groups)were compared.The ROC curves were used to determine the ultrasonic diagnostic indexes and cutoff values of HT in different age groups.Results In different age groups of HT patients,there were statistically significant differences in thyroid echo grade,SWE_(mean) and SWV_(mean)(P<0.05);while in the control group,there were significant differences in SWE_(mean) and SWV_(mean)(P<0.05).The age of HT patients and controls was positively correlated with SWE_(mean) and SWV_(mean)(r=0.231,0.236;r=0.476,0.408;P<0.05).The ROC showed:in all the subgroups,SWE_(mean) had the highest AUC value for diagnosing HT,and as the cutoff values were 13.53,13.78,15.96 kpa,both sensitivity and specificity were higher,which were 95.7%and 80.5%,96.2%and 89.4%,89.4%and 62.5%,respectively.Conclusions Conventional ultrasound and SWE can be used to objectively assess the changes in thyroid gland in HT patients of different ages.Thyroid echo decreases whereas elasticity increases with age.SWE_(mean) can be used as the best ultrasound diagnostic index for HT patients aged 21~35,36

关 键 词：增龄性 超声评估 桥本甲状腺炎 弹性 

分 类 号：R581.4[医药卫生—内分泌] R445.1[医药卫生—内科学]