Baldini M, Castagnone D, Rivolta R, Meroni L, Pappalettera M, Cantalamessa L
Istituto di Medicina Interna, Malattie Infettive e Immunopatologia dell'Università di Milano, IRCCS Ospedale Maggiore di Milano, Italy.
Thyroid. 1997 Dec;7(6):823-8. doi: 10.1089/thy.1997.7.823.
To investigate possible correlations between thyroid vascularization and activity of Graves' disease, we measured blood flow (TBF) at the inferior thyroid artery and intraparenchymal vascularization (number of vessels per square centimeter) by color Doppler ultrasonography (CDU) on Graves' patients at different phases of the disease. We studied 88 patients cross sectionally: 22 untreated; 17 euthyroid after 6 months of methimazole; 49 euthyroid at drug withdrawal after 12 to 24 months of treatment. The patients of the latter group were followed up for 29.1 +/- 6.3 months after discontinuation of treatment. On the day of CDU examination, free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), antiperoxidase and anti-TSH receptor (TRAb) antibodies were measured. Vascularization indices were significantly higher in the Graves' patients than in controls. In the patients euthyroid under treatment, vascularization was not significantly lower than in the untreated group, but TBF and vessel number both appeared clearly reduced in the patients tested at drug withdrawal. The vascularization indices at drug withdrawal were significantly higher in the patients who relapsed than in those in stable remission: TBF (mL/min) 50.6 +/- 36.8 vs. 23.8 +/- 17.5, p = 0.001; vessel number/cm2 1.8 +/- 0.8 vs. 0.8 +/- 0.5, p = 0.002. A multivariate analysis, evaluating the predictive value of vascularization, hormonal and immunological parameters for relapse, demonstrated a significant predictive value for TRAb (RR 8.2; p = 0.001) and a weak predictive value for TBF (RR 1.1; p = 0.02). In conclusion, CDU examination confirms that thyroid hypervascularization in Graves' disease is not related to thyroid hormone circulating levels. The association of increased TBF and high levels of TRAb in the relapsing forms of disease suggests that thyroid hypervascularization is probably related to the activity of the underlying autoimmune processes.
为研究格雷夫斯病甲状腺血管生成与疾病活动之间可能存在的相关性，我们通过彩色多普勒超声（CDU）测量了格雷夫斯病患者在疾病不同阶段甲状腺下动脉的血流量（TBF）及实质内血管生成情况（每平方厘米血管数量）。我们对88例患者进行了横断面研究：22例未经治疗；17例在服用甲巯咪唑6个月后甲状腺功能正常；49例在接受12至24个月治疗后停药时甲状腺功能正常。后一组患者在停药后随访29.1±6.3个月。在进行CDU检查当天，测量了游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、抗过氧化物酶和抗TSH受体（TRAb）抗体。格雷夫斯病患者的血管生成指数显著高于对照组。在接受治疗且甲状腺功能正常的患者中，血管生成情况并不显著低于未治疗组，但在停药时接受检测的患者中，TBF和血管数量均明显减少。复发患者停药时的血管生成指数显著高于病情稳定缓解的患者：TBF（mL/min）为50.6±36.8 对比 23.8±17.5，p = 0.001；血管数量/平方厘米为1.8±0.8 对比 0.8±0.5，p = 0.002。一项多变量分析评估了血管生成、激素和免疫参数对复发的预测价值，结果显示TRAb具有显著预测价值（相对危险度RR 8.2；p = 0.001），TBF具有较弱预测价值（RR 1.1；p = 0.02）。总之，CDU检查证实格雷夫斯病中甲状腺血管增生与甲状腺激素循环水平无关。在疾病复发形式中TBF增加与TRAb水平升高的关联表明，甲状腺血管增生可能与潜在自身免疫过程的活动有关。
