[彩色多普勒超声、甲状腺功能及自身抗体在妊娠期格雷夫斯病筛查中的作用]

[The role of color doppler ultrasonography, thyroid function and auto antibody for the screening of Graves' disease in pregnancy].

作者信息

Xue M, Shi Q L, Tan K N, Wu Y, Zhou R

机构信息

Department of Endocrinology Shenzhen People's Hospital, Shenzhen 518020, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2016 Jun;55(6):470-3. doi: 10.3760/cma.j.issn.0578-1426.2016.06.014.

DOI:10.3760/cma.j.issn.0578-1426.2016.06.014

PMID:27256611

Abstract

OBJECTIVE

To determine whether color doppler ultrasonography (CDU), thyroid function or thyroid autoimmune antibodies could identify Graves' disease in pregnancy(GDP) in pregnant patients with newly diagnosed thyrotoxicosis.

METHODS

It is an observational study. Sixty-eight pregnant patients with newly diagnosed thyrotoxicosis including gestational hyperthyroidism(GHT) subjects (GHT group, n=33) and GDP subjects (GDP group, n=35), and 62 age-and sex-matched healthy subjects (C1 group: pregnant, n=32, C2 group: non-pregnant, n=30) were recruited. Thyroid function, human chorionic gonadotropin(HCG), thyroid autoimmune antibodies were detected. Peak systolic velocity of the superior thyroid artery (STA-PSV) and diastole inner diameter(STA-D) of the superior thyroid artery were measured by CDU. A ROC curve was used to evaluate STA-PSV, STA-D, thyroid function and thyroid autoimmune antibodies for identification of GDP.

RESULTS

The area under the ROC curve of STA-PSV, STA-D and thyroid stimulating hormone (TSH), free T4 (FT4) for GDP were 0.905, 0.887, 0.803 and 0.786, respectively. The optimal cut-off points of STA-PSV, STA-D, TSH and FT4 for GDP were 40 cm/s, 2.0mm, 0.03 mIU/L and 30 pmol/L with the sensitivity of 82.9%, 72.1%, 81.8%, 76.2% and specificity of 81.8%, 87.9%, 75.2%, 80.3%, respectively.

CONCLUSIONS

Detection of STA-PSV and STA-D by CDU, as well as thyroid function, is useful in screening GDP in pregnant patients with thyrotoxicosis.

摘要

目的

确定彩色多普勒超声（CDU）、甲状腺功能或甲状腺自身抗体能否鉴别新诊断甲状腺毒症的妊娠患者中的妊娠合并格雷夫斯病（GDP）。

方法

这是一项观察性研究。招募了68例新诊断甲状腺毒症的妊娠患者，包括妊娠甲亢（GHT）患者（GHT组，n = 33）和GDP患者（GDP组，n = 35），以及62例年龄和性别匹配的健康受试者（C1组：妊娠，n = 32，C2组：非妊娠，n = 30）。检测甲状腺功能、人绒毛膜促性腺激素（HCG）、甲状腺自身抗体。用CDU测量甲状腺上动脉收缩期峰值流速（STA - PSV）和甲状腺上动脉舒张期内径（STA - D）。采用ROC曲线评估STA - PSV、STA - D、甲状腺功能和甲状腺自身抗体对GDP的鉴别能力。

结果

STA - PSV、STA - D以及促甲状腺激素（TSH）、游离T4（FT4）对GDP的ROC曲线下面积分别为0.905、0.887、0.803和0.786。STA - PSV、STA - D、TSH和FT4对GDP的最佳截断点分别为40 cm/s、2.0mm、0.03 mIU/L和30 pmol/L，敏感性分别为82.9%、72.1%、81.8%、76.2%，特异性分别为8l.8%、87.9%、75.2%、80.3%。