ARFI在妊娠早中期甲状腺功能减退性疾病的初步研究

发布时间：2019-01-16 07:31

【摘要】：[目的]探讨声辐射力脉冲弹性成像(Acoustic radiation force impulse,ARFI)的声触诊组织量化技术(Virtual touch tissue quantification, VTQ)与声触诊组织成像量化技术(Virtual touch tissue imaging quantification,VTIQ)对妊娠早中期女性甲状腺功能减低性疾病的应用价值。[方法]选取2016年7月-2017年1月在我院就诊的妊娠早中期甲状腺功能减低症患者65例作为总甲减组,参照2011年《妊娠和产后甲状腺疾病诊断和处理:美国甲状腺学会指南》,根据甲状腺功能将总甲减组又分为甲减组及亚甲减组,其中甲减组15例,亚甲减组50例,另选取35例甲功正常的妊娠早中期女性作为对照组。使用Siemens Acuson Helx S3000型超声诊断仪,配备VTQ及VTIQ技术软件的9L4线阵探头,观察甲状腺的大小、形态、回声及测量甲状腺上动脉的峰值流速(Peak systolic velocity ,PSV)及阻力指数(Resistance index,RI)再用VTQ条件测量甲状腺右侧叶的剪切波速度(Shear wave velocity, SWV),然后用VTIQ彩色模式(VTIQ-C)测量甲状腺右侧叶的SWV值,最后用VTIQ灰阶模式(VTIQ-B)测量甲状腺右侧叶的SWV值。应用SPSS21.0统计软件进行统计分析。[结果]1、甲减组、亚甲减组及对照组之间体积、PSV、RI差异均无统计学意义。2、正常妊娠早、中期VTQ模式下SWV值参考值范围为1.88±0.36m/s, VTIQ模式下SWV参考值范围为2.12±0.17m/s。3、VTQ模式下甲减组与对照组、亚甲减组与对照组及甲减组与亚甲减组之间的SWV值差异无统计学意义,VTQ模式下总甲减组与对照组之间差异有统计学意义(P=0.042)。VTIQ模式下甲减组与对照组之间差异有统计学意义(P=0.004),亚甲减组与对照组之间差异有统计学意义(P=0.045),甲减组与亚甲减组之间差异无统计学意义(P=0.253)。VTIQ模式下总甲减组与对照组之间差异有统计学意义(P0.0001)。4、VTQ与VTIQ两种模式下的SWV值比较,对照组、亚甲减组差异均有统计学意义(均为P0.0001);甲减组差异无统计学意义(P=0.278);总甲减组差异有统计学意义(P0.0001)。在VTIQ-C与VTIQ-B模式下的SWV值比较,甲减组、亚甲减组及对照组均差异无统计学意义,P值分别约(0.313、0.161、0.191)。5.亚甲减组早孕期与中孕期VTQ及VTIQ两种模式下的SWV值差异均无统计学意义(P0.05)。甲减组与亚甲减组中血清中TSH滴度与VTQ及VTIQ两种技术所测的SWV值均无相关性。[结论]1、常规超声对妊娠期甲状腺减低性疾病的诊断特异性不明显。2、本研究正常妊娠早、中期女性VTQ模式下SWV值参考值范围为1. 88±0. 36m/s,VTIQ 模式下 SWV 参考值范围为 2. 12±0. 17 m/s。3、ARFI的VTQ与VTIQ技术在对甲状腺组织的软硬度定量、定性评估上有一定价值。4、同一患者VTQ与VTIQ所测的SWV值有显著统计学差异,是由于VTQ的局限性所致。5、VTIQ的灰阶和彩色两种模式测量得出的SWV值均比较稳定,各有优劣,可以互补。6、孕妇亚临床甲状腺功能减低症SWV值不受妊娠孕周的影响。7、VTQ及VTIQ两种模式下测得的妊娠期甲状腺功能减低性疾病的SWV均与TSH滴度无相关性。
[Abstract]:[objective] to investigate the quantitative technique of acoustic palpation tissue imaging (Virtual touch tissue quantification, VTQ) and acoustic palpation tissue imaging (Virtual touch tissue imaging quantification,) in acoustic radiation pulse elastic imaging (Acoustic radiation force impulse,ARFI). The value of VTIQ in the treatment of hypothyroidism in women in early and second trimester of pregnancy. [methods] Sixty-five patients with hypothyroidism in the first trimester of pregnancy from July 2016 to January 2017 were selected as the total hypothyroidism group. According to thyroid function, the total hypothyroidism group was divided into hypothyroidism group (15 cases) and hypothyroidism group (50 cases). Using Siemens Acuson Helx S3000 ultrasonic diagnostic instrument and 9L4 linear array probe equipped with VTQ and VTIQ software, the size, shape, echo and peak velocity of the superior thyroid artery (Peak systolic velocity, PSV) and resistance index (Resistance index,) were observed. RI) the shear wave velocity (Shear wave velocity, SWV),) of the right lobe of the thyroid gland was measured by VTQ condition, and the SWV value of the right lobe of the thyroid gland was measured by VTIQ color mode (VTIQ-C). Finally, the SWV value of the right lobe of thyroid gland was measured by VTIQ gray scale model (VTIQ-B). SPSS21.0 statistical software was used for statistical analysis. [results] 1. There was no significant difference in volume and PSV,RI between hypothyroidism group, hypothyroidism group and control group. 2. The reference range of SWV value in normal pregnancy was 1.88 卤0.36 m / s in VTQ mode, and there was no significant difference in SWV between hypothyroidism group, subhypothyroidism group and control group. There was no significant difference in SWV between hypothyroidism group and control group, hypothyroidism group and control group and hypothyroidism group. There was significant difference between the total hypothyroidism group and the control group in VTQ mode (P0. 042). VTIQ model), the difference between the total hypothyroidism group and the control group was statistically significant (P0. 004). There was significant difference between hypothyroidism group and control group (P0. 045). There was no significant difference between hypothyroidism group and subhypothyroidism group (P0. 253). VTIQ). There was significant difference between total hypothyroidism group and control group (P0. 0001). There was significant difference in subhypothyroidism group (P0.0001). There was no significant difference between hypothyroidism group (P0. 278) and total hypothyroidism group (P0. 0001). There was no significant difference in SWV value between hypothyroidism group, hypothyroidism group and control group in VTIQ-C and VTIQ-B model, P value was about (0.313 卤0.161 卤0.191). There was no significant difference in SWV between early pregnancy group and VTQ and VTIQ model in hypothyroidism group (P0.05). There was no correlation between serum TSH titer and SWV measured by VTQ and VTIQ in hypothyroidism and hypothyroidism groups. [conclusion] 1, the specificity of conventional ultrasound in the diagnosis of hypothyroidism in pregnancy is not obvious. 2. In this study, the reference range of SWV value in normal early pregnancy and middle term female VTQ model is 1. 88 卤0. The SWV reference range for 36 m / s / s VTIQ is 2. 5%. 12 卤0. 17 m / s. 3 ARFI VTQ and VTIQ techniques have a certain value in quantitative and qualitative evaluation of thyroid tissue. 4. There is significant difference in SWV between VTQ and VTIQ in the same patient, which is due to the limitation of VTQ. The SWV values measured by the gray scale and color models of VTIQ were both stable and had advantages and disadvantages, which could complement each other. 6. The SWV value of subclinical hypothyroidism in pregnant women was not affected by gestational weeks. There was no correlation between SWV and TSH titer in pregnant women with hypothyroidism by VTQ and VTIQ.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256;R445.1

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