超声弹性成像评分法评价桥本甲状腺炎病程进展的可行性

摘要

目的 探讨超声弹性成像评分法对桥本甲状腺炎(HT)病程进展的诊断价值.方法收集106例经临床确诊的HT患者,根据甲状腺功能分为HT甲亢组、HT甲功正常组、HT亚临床甲减组、HT临床甲减组,并以50名正常人作为正常对照组.应用弹性成像技术对所有受试者进行检查并评分.结果 正常对照组、HT甲亢组、HT甲功正常组、HT亚临床甲减组、HT临床甲减组弹性图像评分依次增高,分别为(1.036±0.216)分、(1.757±0.527)分、(2.334±0.450)分、(2.391±0.541)分、(2.683±0.460)分,组间差异有统计学意义(χ2=45.883,P=0.000).且正常对照组弹性图像评分低于HT甲亢组、HT甲功正常组、HT亚临床甲减组、HT临床甲减组,差异均有统计学意义(t=4.580、9.992、9.426、11.156,P均<0.01);HT甲亢组弹性图像评分低于HT甲功正常组、HT亚临床甲减组、HT临床甲减组,差异均有统计学意义(t=3.483、3.590、5.146,P均<0.01);HT甲功正常组弹性图像评分低于HT临床甲减组,差异有统计学意义(t=2.227,P<0.05).正常对照组、HT甲亢组、HT甲功正常组、HT亚临床甲减组、HT临床甲减组血清促甲状腺激素(TSH)水平分别为(2.24±0.26)、(0.06±0.12)、(2.14±1.02)、(10.79±6.25)、(46.94±23.78)μIU/ml.HT患者甲状腺弹性图像评分与血清TSH水平呈正相关(r=0.494,P=0.000),HT患者甲状腺弹性图像评分随血清TSH的增加而增加,线性回归方程为Y=1.763+0.014X(Y为弹性成像评分,X为血清TSH).结论 超声弹性图像评分有助于评价HT的病程进展情况.%Objective To investigate the value of ultrasound elastography in the diagnosis of progression of Hashimoto's thyroiditis( HT ). Methods One hundred and six patients clinically diagnosed as HT were enrolled in this study. According to the function of thyroid, the patients were classified into four groups: the hyperthyroidism group, the euthyroidism group, the subclinical hypothyroidism group and the clinical hypothyroidism group. Fifty volunteers with normal thyroid functions were enrolled as control group. All subjects were examined by ultrasound elastography and scored. Results The score increased in the order of the control group,the hyperthyroidism group,the euthyroidism group,the subclinical hypothyroidism group and the clinical hypothyroidism group,the corresponding scores were( 1.036 ±0. 216 ),( 1.757 ±0. 527 ), ( 2. 334 ± 0. 450 ), ( 2. 391 ± 0. 541 )and( 2. 683 ± 0. 460 ), respectively. The elastographic grades in the control group were lower comparing to the hyperthyroidism group, the euthyroidism group, the subclinical hypothyroidism group and the clinical hypothyroidism group,( t =4. 580,9. 992,9.426,11.156,all P<0. 01 ). The HT patients with hyperthyroidism had lower elastographic grades than patients in the euthyroidism group, the subclinical hypothyroidism group and the clinical hypothyroidism group( t = 3. 483,3. 590,5. 146, all P <0. 01 ). HT patiens with euthyroidism had lower elastographic grades than the other HT patients with clinical hypothyroidism( t = 2. 227, P < 0. 05 ). The serum TSH of the control group, the hyperthyroidism group,the euthyroidism group, the subclinical hypothyroidism group,the clinical hypothyroidism group were ( 2.24 ± 0. 26 ), ( 0. 06 ± 0. 12 ), ( 2. 14 ± 1. 02 ), ( 10. 79 ± 6. 25 ) and( 46. 94 ± 23. 78 ) μIU/ml, respectively. The Spearman's correlation coefficient between the elasticity scores and the serum TSH was 0. 494( P = 0. 000 ). The equation of linear regression was presented as Y = 1. 763 + 0. 014X( Y = elasticity score,X = serum TSH );the elasticity score increased with the rise of serum TSH. Conclusion Elastography is valuable to assess the progression of HT.