彩色多普勒超声定量参数鉴别毒性弥漫性甲状腺肿和无痛性甲状腺炎的临床价值

摘要

目的 探讨彩色多普勒超声定量参数鉴别诊断毒性弥漫性甲状腺肿(GD)和无痛性甲状腺炎(PT)的临床价值.方法 回顾性分析117例GD患者(GD组)、109例PT患者(PT组)及34例正常志愿者(健康对照组)的临床资料和彩色多普勒超声图像资料,绘制受试者工作特征(ROC)曲线,评价甲状腺上动脉峰值流速(STA-PSV)和甲状腺血流面积(TBFA)鉴别GD和PT的诊断价值;并对促甲状腺素(TSH)、游离甲状腺素(FT4)及游离三碘甲状腺原氨酸(FT3)与STA-PSV和TBFA的相关性进行分析.结果 GD组STA-PSV为(84.8±27.9)cm/s,TBFA为(36.75±15.23)%;PT组STA-PSV为(26.3±9.3)cm/s,TBFA为(6.45±3.49)%,两组比较差异均有统计学意义(均P<0.05).STA-PSV诊断GD和PT的敏感性为0.86,准确率为1.0,ROC曲线下面积为0.946;TBFA诊断GD和PT的敏感性为0.71,准确率为1.0,ROC曲线下面积为0.913.GD患者TSH、FT4、FT3水平与STA-PSV、TBFA均呈弱相关(均P<0.05).结论 彩色多普勒超声定量参数能有效鉴别GD与PT,具有重要的临床应用价值.%Objective To explore the value of color Doppler ultrasound and it quantitative parameters in the differential diagnosis of Graves' disease and painless subacute thyroiditis. Methods The clinical data and color Doppler ultrasound quantitative parameters of 117 patients with Graves' disease(GD group),117 patients with painless thyroiditis(PT group),and 34 healthy volunteers were retrospectively analyzed.The ROC curve was depicted.The peak systolic blood-flow velocity in the superior thyroid artery(STA-PSV) and thyroid blood flow area(TBFA) were investigated for the differential diagnosis of Graves' disease and painless thyroiditis . The thyrotropin-stimulating hormone(TSH), free thyroxine(FT4) and free tri-iodothyronine(FT3) were correlatively analyzed with STA-PSV and TBFA. Results The STA-PSV and TBFA in GD group were(84.8±27.9)cm/s and(36.75±15.23)%,respectively.Whereas they were(26.3±9.3)cm/s and(6.45±3.49)%in PT group,respectively.The differences were statistically significant(all P<0 . 05). The diagnostic sensitivity , accuracy , area under the ROC curve of GD and PT by STA-PSV were 0.86,1.0,0.946,respectively,and they were 0.71, 1.0,0.913 by TBFA.The TSH,FT4,FT3 levels in GD group were positively correlated with STA-PSV and TBFA(all P<0.05). Conclusion Color Doppler ultrasound can effectively distinguish from GD and PT with an important clinical value.