原发性甲状腺功能亢进症的超声声像与相关因素分析

目的探讨二维超声及彩色多普勒血流显像（CDFI）对未经治疗的原发性甲状腺功能亢进症（甲亢）的声像表现及其相关的因素。方法对59例未经治疗的甲亢患者的甲状腺行二维超声及CDFI,根据甲亢患者甲状腺不同的超声表现分成均匀回声型（24例）及不均匀回声型（35列）,同时检测甲状腺激素及甲状腺自身抗体,并与健康对照组比较。结果甲亢在甲状腺体积、血流、甲状腺功能与健康对照组比较差异有统计学意义（P〈0.05）,甲亢组甲状腺上动脉血流速度、甲状腺体积均高于健康对照组,阻力指数低于健康对照组。均匀回声型及不均匀回声型间的血流、甲状腺激素水平差异无统计学意义（P〉0.05）,但不均匀回声型的抗体TGAb和/或TMAb水平高于均匀回声型（P〈0.05）。甲亢组的甲状腺上动脉Vmax与TT3、TT4正相关（r=0.308、0.426,P〈0.05）,甲状腺体积与TT3、TT4、TRAb均无相关（r=0.087、0.084、0.213,P〉0.05）;TRAb与TT3、TT4无相关（r=0.103、0.125,P〉0.05）。结论甲亢患者的甲状腺超声表现有2种均匀回声型和不均匀回声型,其不均匀回声可能与TGAb和/或TMAb的水平高有关,这对临床治疗方法的选择有一定的参考意义。

Ultrasonic characteristics of primary hyperthyroidism and their correlation factors

Objective To study the ultrasonic characteristics of untreated primary hyperthyroidism(PH)by using two-dimensional ultrasound and colour dopplor flow imaging(CDFI)and their correlation factors.Methods Fifty nine cases of PH and 39 healthy volunteers as a control group were enrolled in the study.The volume of thyroid gland was examined by using two-dimensional ultrasound,and systolic and diastolic blood flow velocity(Vmax,Vmin)and resistance index(RI)were examined by using CDFI in the two groups.Serum levels of TT3,TT4,FT3,FT4,rT3,TSH,TRH,TRAb,TGAb and TMAb were also assayed by radioimmunoassay.The correlations between the ultrasonic types of thyroid gland and the serum levels of thyroid hormone and thyroid antibodies were analyzed.Results The serum levels of T T3,T T4,FT3,FT4,TRAb,the volume of thyroid gland,Vmax,and Vmin were significantly increased,and the serum level of TSH and RI were significantly decreased in PH group compared with those in the control group(P<0.05).There were two different ultrasonic types in PH according to the ultrasonic characteristics:homogeneous echo(24 patients)and inhomogeneous echo(35 patients).But there was no static difference in the serum levels of TT3,TT4,TSH,TRAb,the volume of thyroid gland,Vmax,Vmin,and RI between both types of PH(P>0.05).There were positive correlations between Vmax and TT3 and TT4 (r=0.308,0.426,P<0.05)but no correlations between the volume of thyroid gland and TT3 and TT4(r =-0.087,0.084,P>0.05)and no correlations between TRAb and the volume of thyroid gland,TT3,and TT4(r=0.213,-0.103,0.125,P>0.05)in the PH group.There was a static difference in the levels of TGAb and/or TMAb in the type of homogeneous echo compared with the type of inhomogeneous echo(P<0.05) .Conclusion The study indicates that two ultrasonic types of thyroid gland may be found in patients with PH.Inhomogeneous echo of thyroid gland may be related with the high levels of TGAb and/or TMAb.The different ultrasonic types in PH may be valuable in selecting the useful way of clinical treatment.