彩色多普勒超声在亚临床甲状腺功能低下诊断中的应用

目的探讨彩色多普勒超声在亚临床甲状腺功能低下(简称亚甲低)诊断中的应用价值。方法对35例经临床及实验室检查证实的亚甲低患者进行彩色多普勒血流显像(CDFI)检查。同时选择30例健康者(正常组)及20例单纯性甲状腺功能亢进患者(甲亢组)作为对照。结果亚甲低患者甲状腺大部分腺体内血流信号增多,血流速度快,左右两侧甲状腺上动脉血流速度分别为(76.86±25.26)和(79.54±29.83)cm/s。亚甲低组左右两侧甲状腺上动脉血流速度显著高于正常组(P<0.001),低于甲亢组(P<0.001),阻力指数差异均无统计学意义(P>0.05)。结论彩色多普勒超声在亚甲低的诊断中起着重要的作用。     

内分泌系统疾病

20043235甲状膝超声广泛低回声临床意义的探讨/胡凤楠…//中华内分泌代谢杂志一2004,20(2)一110~1 13 对3个农村地区3 546名14岁以上居民进行甲状腺超声、甲状腺功能、甲状腺自身抗体(T从)检查。结果:广泛低回声表现为散在性和弥漫性。自身免疫性甲状腺炎(AITT)组(64例)散在和弥漫性低回声检出率分别为21.9%和46.9%,Graves病(Go)组(42例)为54.8%和19.0%,均高于非毒性甲状腺肿组(494例)和正常对照组(2401例)(尸<0.01),后两者79.6%和99.3%为正常回声。T从阳性组低回声检出率明显高于阴性组(尸<0.01)。弥漫性低回声检出率随甲状腺过氧化物…     

强的松联合消炎痛治疗亚急性甲状腺炎疗效观察

为了探讨不同药物对亚甲炎的临床疗效，减少复发率，将３７例亚甲炎患者随机分为强的松组，消炎痛组，强的松加消炎痛组，并观察其治疗效果，结果，强的松加消炎痛组临床症状改善情况及复发率明显优于其它两组（Ｐ〈０．０５），强的松与消炎痛联合用药较单一用药疗效好，起效快，复发率低。     

甲状腺超声广泛低回声临床意义的探讨

目的　探讨甲状腺超声广泛低回声 (以下称广泛低回声 )在自身免疫性甲状腺病 (AITD)诊断上的临床意义。方法　对 3个农村地区 3 5 46名 14岁以上居民进行甲状腺超声、甲状腺功能、甲状腺自身抗体 (TAA)检查。结果　广泛低回声表现为散在性和弥漫性。自身免疫性甲状腺炎 (AITT)组 ( 64例 )散在和弥漫性低回声检出率分别为 2 1.9%和 46.9% ,Graves病 (GD)组 ( 4 2例 )为 5 4.8%和 19.0 % ,均高于非毒性甲状腺肿组 ( 4 94例 )和正常对照组 ( 2 40 1例 ) (P <0 .0 1) ,后两者 79.6%和 99.3 %为正常回声。TAA阳性组低回声检出率明显高于阴性组 (P <0 .0 1)。弥漫性低回声检出率随甲状腺过氧化物酶抗体、TSH受体抗体 (TRAb)和甲状腺球蛋白抗体水平升高而增加 ,散在性低回声检出率随TRAb水平升高而增加。结论　广泛低回声多见于AITD ,与甲状腺自身免疫明显相关。GD多为散在性低回声 ,AITT多为弥漫性低回声。     

甲状腺放射性核素显像在亚急性甲状腺炎中的临床意义

作者报告15例亚急性甲状腺炎(简称亚甲炎)甲状腺放射性核素显像的结果,其与血沉(ESR)、放射性碘摄取率(RAIU)、甲状腺功能受损程度和病情发展是一致的。亚甲炎甲状腺显像有多种不同表现,熟悉这些特点对诊断有一定意义。亚甲炎患者经地塞米松治疗,效果满意。治疗前后显像结果进行重复比较,尤其是治疗后短时间内复查,对早日确立诊断帮助较大。     

甲状腺功能减退症：彩色多普勒超声在亚临床甲状腺功能低下诊断中的应用

35例经临床及实验室检查证实的亚临床甲状腺功能低下（亚甲低）患者进行彩色多普勒血流显像（CDFI）检查。同时检测健康正常组30例及单纯性甲亢组20例作为对照。结果：亚甲低组高频超声图像表现为甲状腺容积增大、光点粗，     

间质性肺疾病与慢性阻塞性肺疾病急性发作肺超声检查的对照分析

目的比较间质性肺疾病(ILD)与慢性阻塞性肺疾病急性发作(AECOPD)患者的经胸肺超声图像的差异。方法对70例经CT及临床诊断证实的ILD患者及30例AECOPD患者行经胸肺超声检查,观察胸膜有无增厚,胸膜有无凹凸不平整,胸膜下有无低回声区,胸腔有无积液,记录B线条数最多的一个切面所显示的B线条数,比较二者的差异。结果经胸肺超声检查显示,ILD组胸膜增厚超过1.0 mm、胸膜凹凸不平整、一个切面有3条以上的B线及胸膜下有低回声区的比例高于AECOPD组,差异有统计学意义(P0.01)。ILD组有少量胸腔积液的比例低于AECOPD组,差异有统计学意义(P0.05)。结论 ILD的经胸肺超声图像有一定的特征,可以与AECOPD进行鉴别。     

彩超诊断眼眶静脉曲张1例

1病历摘要患者,男,14岁,因左眼球突出5个月就诊。主要表现为左眼球突出、疼痛、眼红、视力明显下降,低头时眼胀眼突明显。眼科检查:常规眼眶平扫未见肿块,静脉加压眶尖见肿块。超声所见:左眼轴长23mm,前房厚约3.9mm,晶体厚2.2mm,玻璃体内未见异常回声,左眼层次清晰,形态结构正常,吸气后眶内眼球后方见管状低回声区,内径约8.3mm,平静呼吸低回声区消失,挤压颈静脉屏气时见管状低回声区。彩色多普勒显像(CDFI):吸气后低回声区显示红色血流信号,呼气时显示蓝色血流信号,测及静脉频谱。各频谱测值如下:低回声区静脉平均流速3.16cm/s,左侧视网膜…     

原发性胆汁性胆管炎超声表现及与实验室指标的相关性研究

目的探讨原发性胆汁性胆管炎(primary biliary cholangitis,PBC)的超声表现,分析不同病理分期的生化、免疫指标的差异。方法回顾性分析病理确诊的75例PBC患者的超声表现、病理资料及临床实验室检查结果,总结不同病理分期超声表现,分析PBC患者的病理分期与肝功能、免疫学指标的相关性。结果不同病理分期的PBC患者超声表现不同:Ⅰ期患者超声表现正常或回声稍增粗,Ⅱ期患者超声表现为回声增粗及呈条索样改变,Ⅲ、Ⅳ期患者超声表现多呈条索及结节样改变,且部分患者可出现门静脉周围的低回声区。对实验室检查与纤维化病理分期的分析显示,ALT、ALP水平在4期之间差异有统计学意义(P均0.05),两两比较发现Ⅲ期ALT、ALP水平大于Ⅰ、Ⅱ期,其余各期之间差异无统计学意义(P均0.05);Ig G水平在4期患者之间差异有统计学意义(P0.05),两两比较发现Ⅳ期水平大于Ⅰ期,其余各期之间差异无统计学意义(P均0.05)。结论超声在PBC各病理分期的特征性影像学改变结合生化免疫指标,可对PBC提供客观的无创诊断依据,并与PBC的病理纤维化程度具有相关性。     

消瘀片消退兔腹主动脉粥样斑块作用的研究

目的 观察消瘀片对兔腹主动脉粥样斑块的消退作用。方法 采用高脂饮食８ｗ加主动脉内膜剥脱术帛成兔腹主动脉粥样硬化模型,通过血管腔内超声技术、光镜和电镜,检查口服消瘀片１６ｗ后兔腹主动脉粥样斑块的消长变化。结果 血管腔内超声检查显示,粥样硬化组管壁呈弥漫性增厚,腔内有环形或半月状粥样斑块低回声区,用消瘀片治疗后,管壁增厚不明显,仅可见散在或短弧形粥样斑块回声区,粥样斑块厚度和斑块面积与粥样硬化组相比明     

Color Doppler ultrasonography in patients with subacute thyroiditis.

We studied the utility of color Doppler ultrasonography in patients with subacute thyroiditis. Eighteen patients with subacute thyroiditis (SAT) with painful goiter and thyrotoxicosis underwent color Doppler ultrasonography during the acute and recovery stages of the disease. Thyroid vascularization in these patients was compared with that of 15 untreated patients with Graves' disease and 17 control subjects. During the acute stage of subacute thyroiditis, color Doppler ultrasonography showed low echogenicity without increased tissue vascularity in the affected swollen thyroid. In the recovery stage, color Doppler ultrasonography showed isoechogenicity with slightly increased vascularization. Vascularization became normal at 1 year follow-up time. In contrast, marked by increased vascularization was observed in patients with untreated Graves' disease. Color Doppler ultrasonography showed clear differences between SAT and Graves' disease patients. Vascularity was significantly correlated with serum free thyroxine (FT4) and thyrotropin (TSH) concentrations in the recovery stage (3 months after the initial ultrasonography). Color Doppler ultrasonography accurately visualized lesions without increased vascularity in the acute stage of SAT and lesions of slightly increased vascularity in the recovery stage. Color Doppler ultrasonography may be a useful, noninvasive, and rapid method for differentiating SAT from Graves' disease and for evaluating and monitoring the location and activity of lesions in SAT.     

Quantitative measurement of thyroid blood flow for differentiation of painless thyroiditis from Graves' disease

OBJECTIVE: Differentiation between destruction-induced thyrotoxicosis and Graves' thyrotoxicosis is important for selection of proper therapy. It is, however, often difficult to make this distinction without measurement of radioactive iodine uptake. We investigated the possibility that assessment of thyroid blood flow would allow differentiation between the two entities. PATIENTS AND MEASUREMENTS: One hundred and fourteen untreated patients with thyrotoxicosis (56 Graves' disease, 28 painless thyroiditis, 30 subacute thyroiditis) and 25 normal controls were examined. Serum levels of freeT4 (FT4), freeT3 (FT3) and TSH were measured by chemiluminescent immunoassay, and anti-TSH receptor antibodies (TSH-binding inhibitory immunoglobulin, TBII) were measured by enzyme-linked immunosorbent assay. Thyroid volume and blood flow (TBF) were measured quantitatively by ultrasonography. RESULTS: TBF was significantly higher in Graves' disease (mean +/- 1SD: 14.9 +/- 6.4%, P < 0.0001) than in painless thyroiditis (0.8 +/- 0.5%), subacute thyroiditis (0.9 +/- 0.7%) and in normal controls (0.8 +/- 0.5%). All patients with Graves' disease had TBF values of more than 4% and all patients with painless thyroiditis and subacute thyroiditis had TBF values less than 4%. TBF values significantly correlated with values of radioactive iodine uptake (RAIU) either at 3 h (r = 0.492, P < 0.01) or 24 h (r = 0.762, P < 0.001) within the Graves' disease and painless thyroiditis groups. There was no relationship between TBF values and thyroid volumes or values of TBII in the Graves' disease group. All patients with Graves' disease had positive TBII of 15% or more. Three of 28 patients with painless thyroiditis and one of 30 patients with subacute thyroiditis had positive TBII. CONCLUSION: TBF was quantitatively measured by power Doppler ultrasonography and was more effective than TBII for differentiation between destruction-induced thyrotoxicosis (painless or subacute thyroiditis) and Graves' thyrotoxicosis. TBF values of less than 4% in untreated thyrotoxic patients are laboratory signals of destruction-induced thyrotoxicosis and if these are determined, the radioactive iodine uptake test can be omitted for differential diagnosis of these two types of thyrotoxicosis.     

Ultrasound appearances in de Quervain's subacute thyroiditis with long-term follow-up.

In order to determine whether permanent echo abnormalities are produced by subacute thyroiditis, ultrasound examination of the thyroid was performed repeatedly after a mean interval of 23 months in 17 subjects (8 women and 9 men) aged 31-52 (mean 41) years, suffering from subacute thyroiditis. The diagnosis was based on typical clinical symptoms, and cytological confirmation was obtained in all subjects but one. In the primary phase the ultrasonic finding was in all cases abnormal, showing either diffuse or focal hypoechogenicity and enlargement of thyroid lobes. At follow-up, a homogenous echo structure was found in 15 patients. Nodularity was detected in only two subjects. It is concluded that permanent focal echo abnormalities are generally not produced by subacute thyroiditis. Consequently, thyroid nodules in subjects with a history of SAT should not be ignored.     

激素治疗亚急性甲状腺炎不同停药指征的疗效观察

目的 探讨激素治疗亚急性甲状腺炎（SAT）不同停药指征的疗效差异.方法 观察组以甲状腺131^I摄取率恢复正常作为激素停药指征,总疗程不少于3个月,对照组以血沉降至正常作为开始停用激素指征,总疗程6～8周,并比较两组的治愈率、复发率和甲减发生率.结果 观察组治愈率为95%,复发率为0%,甲减发生率为5%;对照组治愈率为66.67%,复发率为22.22%,甲减发生率为16.67%,两组比较差异有显著性（P＜0.01）.结论 治疗亚急性甲状腺炎时,以甲状腺吸131^I率恢复正常作为激素停药指征,总疗程不少于3个月,可提高治愈率,避免病情复发,降低甲减发生率.     

Frequency of hypothyroidism after De Quervain thyroiditis and contribution of ultrasonographic thyroid volume measurement

Subacute thyroiditis conventionally recovers without after-effect. Nevertheless some data relate a 5 to 9% occurrence of final hypothyroidism 6 months after the acute stage. We herein studied end-stage hypothyroidism occurrence and effect of thyroid volume alterations on hormonal course during thyroiditis. Twenty-nine cases of subacute thyroiditis were studied. Final thyroid function remained normal in 15 patients (51%) and undetermined in 5 patients (17%). Final hypothyroidism (TSH: 4.5-14.5 microU/mL) occurred in 9 patients (31%). Mean thyroid volume was increased in acute stage in patients with final normal thyroid function (16.6+/-5.7cm(3)) and decreased by 63% during follow-up; final mean thyroid volume was 6.1+/-1.3cm(3). Mean thyroid volume was normal in acute stage in final hypothyroid patients (10.7+/-3.0cm(3)) and decreased by 72% during follow-up; final mean thyroid volume was 3.3+/-1.1cm(3). End-stage mean thyroid volume was significantly lower in final hypothyroid patients (p<0.05) compared to patients with final normal thyroid function. We conclude that the occurrence of final hypothyroidism is underestimated after subacute thyroiditis. Ultrasonographic follow-up might be helpful in the detection of final hypothyroid-risk patients: thyroid volume not increased in acute stage and lower than 5cm(3) during follow-up is one of the ultrasonographic features of these patients.     

Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism

The clinical usefulness of thyroid ultrasonography in the evaluation of patients with autoimmune thyroiditis has been investigated. Thyroid ultrasonography was performed in 1184 consecutive patients attending our clinic, and the echo density of the thyroid parenchyma was evaluated with respect to that of normal thyroid tissue. Diffuse thyroid hypoechogenicity was found in 44 of 238 (18.5%) patients with autoimmune thyroiditis; the degree of hypoechogenicity was significantly correlated with the levels of circulating thyroid autoantibodies. Thyroid function was normal in all 194 patients with normal thyroid echogenicity, whereas hypothyroidism was found in 28 of 44 (63.6%) with reduced thyroid echogenicity. Included in this group were 8 patients, euthyroid at the first observation, who developed hypothyroidism over an 18-month follow-up period. None of the 133 patients with autoimmune thyroiditis and normal thyroid echogenicity followed for the same period of time became hypothyroid. Evidence of diffuse lymphocytic thyroiditis was obtained by histology after thyroidectomy (n = 10) or multiple fine needle aspiration cytology (n = 15) in 25 of the 44 patients with thyroid hypoechogenicity; on the other hand, focal thyroiditis was shown at histology in 8 patients who had normal thyroid echogenicity. In conclusion, diffuse low thyroid echogenicity was found in about 20% of patients with autoimmune thyroiditis. This echographic pattern is indicative of diffuse autoimmune involvement of the gland and is associated with or may predict the development of hypothyroidism.     

Malignant esophageal strictures: Staging accuracy of endoscopic ultrasonography

The prognosis for patients with carcinoma of the esophagus remains poor despite aggressive combination therapies and radical surgical resections. Accuracy of staging esophageal carcinoma by endoscopic ultrasonography is unmatched by that of any other modality. Of patients with esophageal carcinoma, 20% to 36% present with high-grade malignant strictures that preclude passage of the echoendoscope. Aggressive wire-guided dilation followed by complete endoscopic ultrasonographic assessment or endosonography limited to the proximal aspect of the stricture has been used in staging these patients. Of 204 patients with esophageal carcinoma, 51 (25%) presented with high-grade malignant strictures, defined as stenosis precluding passage of the echoendoscope without prior dilation. Thirty-nine of the 51 patients were treated by esophageal resection. Twenty-one of these patients underwent preoperative staging using wire-guided dilation followed by endoscopic ultrasonography, whereas 18 underwent limited endosonographic staging. Correct preoperative assessment of depth of tumor invasion (T stage) was obtained in 33% (7 of 21) of the former group and 28% (5 of 18) of the latter group. Advanced tumor stage (stage III or IV) was present in 90% (35 of 39) of patients presenting with high-grade strictures, indicating a poor prognosis for those patients. The current study demonstrates that (1) approximately 25% of all patients with esophageal carcinoma present with high-grade strictures that preclude passage of the echoendoscope without prior dilation, (2) the majority of patients with high-grade malignant strictures present with advanced disease (stage III or IV), and (3) because of the low accuracy of endoscopic ultrasonography in staging high-grade strictures, the need to subject such patients to invasive staging studies is questionable. (Gastrointest Endosc 1995;41:535-9.)     

Graves病患者血清0：3型耶尔森菌抗体测定及临床意义

应用ＥＬＩＳＡ法测定１４１例Ｇｒａｖｅｓ病患者血清０：３型耶尔森菌（ＹＥ）抗体。同时检测８１例正常人、３６例桥本甲状腺炎、１６例单纯性甲状腺肿、１０例甲状腺腺瘤或腺癌和４例亚急性甲状腺炎。阳性率分别为：正常对照组１６．０％，Ｇｒａｖｅｓ病组５５．３％，桥本甲状腺炎组４１．７％，单纯性甲状腺肿组２５．６％，甲状腺腺瘤和腺癌组１０．０％，４例亚急性甲状腺炎均为阴性。初步观察到ＹＥ抗体与ＴＳＨ受体抗体（ＴＲＡｂ）之间存在相关性（Ｐ＜０．０１）。ＹＥ抗体的测定对于研究耶尔森菌感染在Ｇｒａｖｅｓ病发病机制中的作用、明确病因、协助诊断和指导治疗均有重要意义。     

慢性甲状腺炎超声声像图特征及鉴别诊断分析

目的探讨慢性甲状腺炎的超声声像图特征及鉴别诊断方法。方法应用高分辨率二维超声结合彩色多普勒对67例慢性甲状腺炎行常规检查。结果慢性甲状腺炎超声表现多种多样,其中典型慢性甲状腺炎45例,占67．2％,非典型慢性甲状腺炎22例,占32．8％。典型慢性甲状腺炎表现为甲状腺弥漫性增大,以峡部增厚明显,内部回声多呈粗大网格状,少部分呈虫蚀样改变,回声极不均质。非典型慢性甲状腺炎表现为多发低回声结节型、光点回声增粗型和片状回声减低型。结论掌握各型慢性甲状腺炎的的超声特点及病理改变特点,可减少漏诊及误诊,为临床提供有价值的诊断依据。     

Transient diffuse low thyroid echogenicity in painless postpartum thyroiditis: report of two cases.

We report two cases of chronic autoimmune thyroiditis, one patient with recurrent painless thyroiditis and another with recurrent postpartum thyroiditis. In these two patients, the episode of subacute thyroiditis seemed to be immune mediated. Thyroid ultrasonography showed a diffuse, markedly hypoechogenic gland, coinciding with each of the episodes of transient thyroid dysfunction that reverted to a normal echographic appearance with recovery of normal thyroid function. These two cases show that a diffuse low echogenicity of the thyroid, frequently seen in autoimmune thyroid disorders, can be a reversible event and suggest that the transient nature of certain forms of hypothyroidism may be predicted by a follow-up echographic examination. Further studies with a larger number of patients are required to confirm this observation.