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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2018, Vol. 15 ›› Issue (03) : 213 -217. doi: 10.3877/cma.j.issn.1672-6448.2018.03.010

所属专题： 妇产科超声影像学； 文献； 妇产科超声；

妇产科超声影像学

妊娠期亚临床甲状腺血清学指标异常患者甲状腺超声表现
玄英华1, 岳嵩1, 姜玉新2, 吴青青1,†()   
  1. 1. 100026　首都医科大学附属北京妇产医院超声科
    2. 100730　中国医学科学院　北京协和医学院　北京协和医院超声医学科
  • 收稿日期:2017-10-11 出版日期:2018-03-01
  • 通信作者: 吴青青
  • 基金资助:
    国家重点研发计划(2016YFC1000104); 北京市医院管理局"登峰"人才培养计划(DFL20151302); 首都卫生发展科研专项(首发2014-2-2113); "十二五"国家科技支撑计划(2014BAI06B05); 首都医科大学附属北京妇产医院院内课题(2013-14)

Ultrasonographic manifestations of thyroid with subclinical thyroid serological anomalies during pregnancy

Yinghua Xuan1, Song Yue1, Yuxin Jiang2, Qingqing Wu1,†()   

  1. 1. Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
    2. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2017-10-11 Published:2018-03-01
  • Corresponding author: Qingqing Wu
  • About author:
    Corresponding author: Wu Qingqing, Email:
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玄英华, 岳嵩, 姜玉新, 吴青青. 妊娠期亚临床甲状腺血清学指标异常患者甲状腺超声表现[J]. 中华医学超声杂志（电子版）, 2018, 15(03): 213-217.

Yinghua Xuan, Song Yue, Yuxin Jiang, Qingqing Wu. Ultrasonographic manifestations of thyroid with subclinical thyroid serological anomalies during pregnancy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(03): 213-217.

目的

探讨妊娠期亚临床甲状腺血清学异常患者甲状腺超声表现特点。

方法

选择2014年1月至2015年12月在首都医科大学附属北京妇产医院就诊的53例孕妇进行甲状腺超声检查。入组孕妇在孕早期检测血清促甲状腺激素（TSH）、血清游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPoAb）水平并首次发现甲状腺功能或血清TPoAb抗体水平异常。采用χ2检验比较血清TPoAb≥1300 IU/L和血清TPoAb<1300 IU/L孕妇甲状腺回声异常发生率及腺体血流增多发生率差异。

结果

53例孕妇中21例为亚临床甲状腺功能亢进，10例为亚临床甲状腺功能减低，22例为单纯TPoAb水平增高。21例亚临床甲状腺功能亢进孕妇中，16例不伴有TPoAb水平升高的孕妇甲状腺超声表现未见明确异常，余5例伴有TPoAb水平升高的孕妇中2例孕妇（40.0%）甲状腺实质回声有轻度弥漫性改变；10例亚临床甲状腺功能减低孕妇中，5例不伴有TPoAb水平升高的孕妇中2例孕妇（40.0%）出现甲状腺轻度弥漫性改变，而余5例伴有TPoAb水平升高的孕妇中4例（80.0%）出现甲状腺弥漫性改变；22例单纯TPoAb水平升高的孕妇中，11例孕妇（50.0%）出现甲状腺弥漫性改变。在所有血清TPoAb水平升高的32例孕妇中，9例孕妇血清TPoAb≥1300 IU/L，23例孕妇血清TPoAb<1300 IU/L。血清TPoAb≥1300 IU/L的孕妇甲状腺回声异常发生率高于血清TPoAb<1300 IU/L的孕妇（8/9 vs 9/23），且差异有统计学意义（χ2=6.432，P=0.018）；而两者腺体血流增多发生率差异无统计学意义（6/9 vs 9/23，χ2=1.970，P=0.080）。

结论

妊娠期甲状腺血清学指标异常患者可有不同超声表现，超声表现与血清学表现并不完全一致。

关键词: 超声检查, 甲状腺, 妊娠, 促甲状腺素, 甲状腺过氧化物酶抗体
Objectives

To investigate the features of thyroid ultrasonographic manifestations in patients with subclinical thyroid serological anomalies during pregnancy.

Methods

In present study, a total of 53 women who attended the obstetrics clinic in Beijing Obstetrics and Gynecology Hospital from January 2014 to December 2015 underwent thyroid ultrasound scanning. All women included in this study were checked up for the serological levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody (TPoAb) in the first trimester and were diagnosed as thyroid dysfunction or abnormal level of serological antibody for the first time. The χ2 test was used to compare the incidences of abnormal thyroid echogenicity and increased blood flow in thyroid between groups with serological TPoAb level≥1300 IU/L and<1300 IU/L.

Results

Among 53 cases, 21 were subclinical hyperthyroidism, 10 were subclinical hypothyroidism, and 22 were isolated elevated serum TPoAb cases. Among 21 subclinical hyperthyroid patients, 16 cases without elevated TPoAb were unremarkable on thyroid scanning, while 2 out of the rest 5 cases (40.0%) with increased serum TPoAb demonstrated mild thyroid diffuse abnormal echogenicity. Among 10 subclinical hypothyroid cases, 2 out of 5 cases (40.0%) without elevated TPoAb manifested mild thyroid diffuse abnormal echogenicity, while 4 of 5 cases (80.0%) with elevated TPoAb showed diffuse abnormal echogenicity of thyroid. In 22 women with isolated elevated serum TPoAb, 11(50.0%) demonstrated diffuse thyroid abnormal echogenicity. In all 32 cases with elevated serum TPoAb, the serum TPoAb level was≥1300 IU/L in 9 cases and<1300 IU/L in 23 cases. The incidence of thyroid abnormal echogenicity was higher in women with serum TPoAb level≥1300 IU/L than in women with <1300 IU/L (8/9 vs 9/23), which was statistically significant (χ2=6.432, P=0.018); while no significant difference in the incidence of increased blood flow in both groups was identified (6/9 vs 9/23, χ2=1.970, P=0.080).

Conclusion

The thyroid ultrasonographic manifestations varied in patients with thyroid serologic anomalies during pregnancy, and were not closely consistent with the serological findings.

Key words: Ultrasonography, Thyroid, Pregnancy, Thyrotropin, Thyroid peroxidase antibody
图1~4 甲状腺超声检查显示甲状腺实质回声分度。图1为0度，甲状腺回声均匀，正常；图2为1度，腺体内可见低回声，低回声面积<1/3腺体面积；图3为2度，腺体内低回声增多，低回声面积≥1/3、<2/3腺体面积；图4为3度，腺体内低回声明显增多，低回声面积≥2/3腺体面积
图5~7 甲状腺超声检查示甲状腺腺体内部血流分分度。图5为1度，腺体较大血管内可见血流，血流信号占<1/3腺体面积；图6为2度，腺体实质内血流轻度增加，血流信号占≥1/3，<2/3腺体面积；图7为3度，腺体实质内血流弥漫增多，血流信号占≥2/3腺体面积
表1 甲状腺血清学异常孕妇甲状腺超声表现（例）
分类 例数 甲状腺实质回声 甲状腺腺体血流
0度 1度 2度 3度 1度 2度 3度
亚临床甲状腺功能亢进 ? ? ? ? ? ? ? ?
? TSH浓度降低 16 16 0 0 0 14 2 0
? TSH浓度降低＋TPoAb水平升高 5 3 2 0 0 2 2 1
单纯TPoAb水平升高 22 11 6 5 0 13 5 4
亚临床甲状腺功能减低 ? ? ? ? ? ? ? ?
? TSH浓度升高 5 3 2 0 0 4 1 0
? TSH浓度升高＋TPoAb水平升高 5 1 2 0 2 2 2 1
表2 不同血清TPoAb水平孕妇甲状腺超声表现（例）
分类 例数 甲状腺实质回声 ? 甲状腺腺体血流
0度 1度 2度 3度 ? 1度 2度 3度
TPoAb≥1300 IU/L 9 1 4 3 1 ? 3 5 1
TPoAb<1300 IU/L 23 14 6 2 1 ? 14 4 5
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