超声弹性成像对桥本病甲状腺纤维化程度评估的初步研究

摘要

目的 探讨实时组织超声弹性成像(RTE)应变率值(SR)与桥本甲状腺炎(HT)腺体纤维化程度间的相关性.方法 应用RTE检测80例HT患者的SR;在光镜下观察病理切片,依据Doniach标准,将病例组分为淋巴细胞型(L型)组32例、嗜酸细胞型(O型)组34例、纤维化型(F型)组14例,并以50例甲状腺功能正常者作为对照组,分别统计各组间SR的差异,分析SR与血清促甲状腺激素(TSH)的相关性.结果 SR对照组＜L型组＜O型组＜F型组,两两之间差异有统计学意义(P＜0.05);病例组SR与血清TSH呈正相关(r=0.601,P＜0.05).光镜所见:L型组见功能旺盛的小滤泡团,淋巴细胞浸润以“++～+++”为主,腺体无或见少许纤维组织增生;O型组见嗜酸性变滤泡团,以滤泡上皮细胞嗜酸性变“+++～++++”、纤维组织增生“+～++”为主;F型组见极小滤泡团,纤维组织增生以“+++～++++”为主.结论 SR与HT组织纤维化程度之间有一定的相关性,纤维化程度越重,SR越大,甲状腺功能越差.%Objective To investigate the correlation between strain ratio(SR) of real-time tissue elastography (RTE) and the degree of fibrosis in Hashimoto's thyroiditis(HT).Methods The SR of 80 HT patients was examined by RTE.The pathological lesions were observed by using optical microscope and those patients were divided into 3 groups according to Doniach standard.:the lymphocytic group,the oxyphilic group,and the fibrous group.50 volunteers with normal thyroid functions were enrolled as a control group,the correlation coefficient between the SR and the serum thyroid stimulating hormone(TSH) was evaluated and the differences of SR among each group were statistically analyzed.Results The Spearman's correlation coefficient between the SR and the serum TSH was 0.601,which was significant (P ＜ 0.05).The SR increased in an ascending order among the control group,the lymphocytic group,the oxyphilic group,and the fibrous group(P ＜0.05).As shown on the optical microscope:the lymphocytic group showed the vigorous functioning small follicular which mainly was lymphocyte infiltration in “ + + ～ + + + ” without glands or a few fibrosis; the oxyphilic group showed oxyphilic-changed epithelium mass which mainly were follicular epithelial cells eosinophilic change “ + + + ～ + + + + ” and fibrous tissue hyperplasia“ + ～ + + ”;the fibrous group showed tiny follicular which mainly was fibrous tissue hyperplasia “ + + + ～ + + + + ”.Conclusions There is certain linear relationship between SR and fibrosis degree of HT.The heavier the degree of fibrosis and the greater the SR was,the worse the thyroid function would be.