剪切波弹性成像评估硒酵母治疗桥本甲状腺炎疗效  

Shear wave elastography evaluates the efficacy of selenium yeast in the treatment of Hashimoto thyroiditis

作　　者：陈正秀 冉张申 CHEN Zhengxiu;RAN Zhangshen(Graduate School of Shandong First Medical University(Shandong Academy of Medical Science),Shandong,Tai’an 271000,China;Cadre Health Care and Physical Examination Center,the Second Affiliated Hospital of Shandong First Medical University,Shandong,Tai’an 271000,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)研究生院,山东泰安271000 [2]山东第一医科大学第二附属医院干部保健与查体中心,山东泰安271000

出　　处：《中国现代医生》2022年第35期10-14,共5页China Modern Doctor

基　　金：山东省医药卫生科技发展计划(202009020793)。

摘　　要：目的探讨剪切波弹性成像(shear-wave elastography,SWE)相关指标评价硒酵母辅助治疗桥本甲状腺炎(Hashimoto thyroiditis,HT)疗效的作用。方法选取2021年11月至2022年7月山东第一医科大学第二附属医院收治的处于亚临床性甲状腺功能减退的60例HT患者为研究对象,采用抽签法随机分为对照组和补硒组,每组各30例。对照组采取生理治疗量的左甲状腺素钠片治疗,补硒组在对照组基础上增加硒酵母治疗,分析两组的治疗效果及治疗前后甲状腺硬度、血清硒(selenium,Se)浓度、甲状腺功能和甲状腺抗体的变化及相关性。结果治疗后补硒组游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、血清Se浓度均升高,平均甲状腺杨氏模量值(mean thyroid Young’s modulus,Emean)、促甲状腺激素(thyrotropin,TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)均降低,差异有统计学意义(P<0.05);对照组治疗后FT3、FT4显著升高(P<0.05),其余指标比较差异无统计学意义(P>0.05);补硒组有效率高于对照组,差异有统计学意义(P<0.01);不良反应发生率低于对照组,但差异无统计学意义(P>0.05);血清Se浓度与Emean呈负相关(P<0.01),与FT4呈正相关(P<0.05)。结论硒酵母可降低HT患者抗体水平、恢复甲状腺功能且不增加不良反应,其联合左甲状腺素疗效好于单用左甲状腺素者;SWE可定量获得甲状腺组织的硬度并可客观评价硒酵母治疗HT的疗效,SWE值可作为HT预后的定量指标。Objective To investigate the role of shear wave elastography(SWE)related indicators in evaluating the efficacy of selenium yeast in the adjuvant treatment of Hashimoto thyroiditis(HT).Methods A total of 60 HT patients in subclinical hypothyroidism admitted to the Second Affiliated Hospital of Shandong First Medical University from November 2021 to July 2022 were selected and randomly divided into a control group and a selenium supplementation group using a lottery method,with 30 cases in each group.The control group was treated with a physiological therapeutic amount of levothyroxine sodium tablets,and the selenium supplement group was treated with selenium yeast on the basis of the control group.The two groups’therapeutic effect and the changes and dependency of the thyroid hardness,serum selenium(Se)concentrations,thyroid function and thyroid antibodies were analyzed before and after treatment.Results After treatment,the concentrations of free triiodothyronine(FT3),free thyroxine(FT4)and Se were increased,and mean thyroid Young’s modulus(Emean),thyrotropin(TSH),thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb)were all reduced in the selenium supplementation group,and the differences were statistically significant(P<0.05).After treatment in the control group,FT3 and FT4 increased signficantly(P<0.05),and the differences in other indicators were not statistically significant(P>0.05).The efficiency of selenium supplementation group was higher than that of the control group,and the difference was statistically significant(P<0.01),and the incidence of adverse reactions was lower than that of the control group,but the difference was not statistically significant(P>0.05).Serum Se concentrations were negatively correlated with Emean(P<0.01),and positively correlated with FT4(P<0.05).Conclusion Selenium yeast can reduce antibody levels in HT patients,restore thyroid function without increasing adverse reactions,and its combined levothyroxine is more effective than that of levothyroxine alone.SWE can qu

关 键 词：桥本甲状腺炎 剪切波弹性成像 硒酵母 杨氏模量 亚临床性甲状腺功能减退症 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581.4[医药卫生—诊断学]