甲状腺功能指标联合经颅多普勒超声及颈动脉超声在动脉粥样硬化性脑梗死血管狭窄评估中的应用  

Application of Thyroid Function Indicators Combined with Transcranial Doppler Ultrasound and Carotid Ultrasound in the Assessment of Vascular Stenosis in Atherosclerotic Cerebral Infarction

作　　者：薛佳佳 王肖肖 王旭 孙源源 朱弘璐 XUE Jiajia;WANG Xiaoxiao;WANG Xu;SUN Yuanyuan;ZHU Honglu(Neurological Function Examination Room,Handan First Hospital,Handan Hebei 056000,China;Department of Neurology,Handan First Hospital,Handan Hebei 056000,China;Color Ultrasound Room,Handan First Hospital,Handan Hebei 056000,China;CT Room,Handan First Hospital,Handan Hebei 056000,China)

机构地区：[1]邯郸市第一医院神经内科功能检查室,河北邯郸056000 [2]邯郸市第一医院神经内科,河北邯郸056000 [3]邯郸市第一医院彩超室,河北邯郸056000 [4]邯郸市第一医院CT室,河北邯郸056000

出　　处：《昆明医科大学学报》2025年第3期103-109,共7页Journal of Kunming Medical University

基　　金：河北省重点研发计划项目(22077710674D)。

摘　　要：目的 探究甲状腺功能指标[促甲状腺激素(thyroid stimulating hormone,TSH)、游离甲状腺素(free thyroxine,FT4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)]联合经颅多普勒超声(transcranial doppler ultrasound,TCD)及颈动脉超声对动脉粥样硬化性脑梗死(atherosclerotic cerebral infarction,ASCI)血管狭窄的评估价值。方法 选取2021年10月至2023年9月邯郸市第一医院收治的182例ASCI患者,均行TCD、颈动脉超声及甲功3项检查,以数字减影血管造影术为金标准,分析TCD、颈动脉超声联合TSH、FT4、FT3对ASCI血管狭窄的评估作用。结果 182例ASCI患者经数字减影血管造影(digital subtraction angiography,DSA)证实颈内动脉血管轻度狭窄64例(35.16%),中度狭窄69例(37.91%),重度狭窄29例(15.93%),完全闭塞20例(10.99%)。不同血管狭窄程度各组临床资料比较差异无统计学意义(P> 0.05);不同血管狭窄程度各组颈内动脉收缩期最大流速(peak systolic velocity,PSV)、舒张末期流速(end-diastolic volume,EDV)随着血管狭窄程度加重呈升高趋势,搏动指数(pulse index,PI)、阻力指数(resistance Index,RI)、管径(diameter,D)随着血管狭窄程度加重呈降低趋势(P <0.05);不同血管狭窄程度各组TSH、FT4随着血管狭窄程度加重呈升高趋势,FT3随着血管狭窄程度加重呈降低趋势(P <0.05);TSH、FT4与血管狭窄程度呈正相关,FT3与血管狭窄程度呈负相关(P <0.05);TSH、FT4与PSV、EDV呈正相关,与RI、PI、D呈负相关,FT3与RI、PI、D呈正相关,与PSV、EDV呈负相关(P <0.05);RI、PI、D、PSV、EDV、TSH、FT4、FT3联合评估ASCI血管狭窄程度的AUC值最大,为0.941(P <0.05)。结论 TCD、颈动脉超声联合甲功3项对ASCI颈内血管狭窄评估有较高价值,RI、PI、D、PSV、EDV、TSH、FT4、FT3联合评估有利于诊断不同程度血管狭窄,为临床提供治疗参考。Objective To explore the evaluation value of thyroid function indicators[thyroid stimulating hormone(TSH),free thyroxine(FT4),free triiodothyronine(FT3)]combined with transcranial Doppler ultrasound(TCD)and carotid ultrasound in the assessment of vascular stenosis in atherosclerotic cerebral infarction(ASCI),providing a reference for clinical targeted treatment.Methods A total of 182 patients with ASCI admitted to Handan Frist Hospital from October 2021 to September 2023 were selected and all of them underwent TCD,carotid artery ultrasound and thyroid function examination.Digital subtraction angiography was used as the gold standard to analyze the evaluation effect of TCD and carotid artery ultrasound combined with TSH,FT4 and FT3 in vascular stenosis of ASCI.Results Among the 182 patients with ASCI,DSA confirmed 64 cases(35.16%)with mild internal carotid artery stenosis,69 cases(37.91%)with moderate stenosis,29 cases(15.93%)with severe stenosis,and 20 cases(10.99%)with complete occlusion.There was no statistically significant difference in clinical data among groups with different degrees of vascular stenosis(P>0.05).The peak systolic velocity(PSV)and end-diastolic volume(EDV)of the internal carotid artery in different groups with different degrees of vascular stenosis showed an increasing trend with the severity of vascular stenosis,while the pulse index(PI),resistance index(RI),and diameter(D)showed a decreasing trend(P<0.05).In different groups with different degrees of vascular stenosis,TSH and FT4 levels increased with the severity of stenosis,while FT3 levels decreased(P<0.05).TSH and FT4 were positively correlated with the degree of vascular stenosis,while FT3 was negatively correlated(P<0.05).TSH and FT4 were positively correlated with PSV and EDV,and negatively correlated with RI,PI,and D.FT3 was positively correlated with RI,PI,and D,and negatively correlated with PSV and EDV(P<0.05).The combined evaluation of RI,PI,D,PSV,EDV,TSH,FT4,and FT3 yielded the highest area under the curve(AUC)value of 0.941 f

关 键 词：动脉粥样硬化性脑梗死 经颅多普勒超声 颈动脉超声 促甲状腺激素 游离甲状腺素 游离三碘甲状腺原氨酸 血管狭窄 

分 类 号：R972.6[医药卫生—药品] O426[医药卫生—药学]