探讨红细胞能量成像（CFA）技术定量评估甲状腺弥漫性病变患者甲状腺功能的应用价值。

选取2016年10月至2017年6月哈尔滨医科大学附属第一医院就诊的甲状腺弥漫性病变患者100例。其中甲状腺功能正常者36例（甲弥甲功正常组），甲状腺功能异常者64例，包括甲状腺功能亢进者30例（甲弥甲亢组），甲状腺功能减低者34例（甲弥甲减组）。另选择同期该院体检的健康志愿者30名（健康对照组）。所有受试者均采用CFA技术测定甲状腺实质感兴趣区内的血流参数：血管指数（VI）与Vascularity。采用单因素方差分析比较4组受检者VI、Vascularity差异，进一步组间两两比较采用SNK-q检验。以临床诊断作为金标准，绘制VI鉴别诊断甲状腺弥漫性病变患者甲状腺功能亢进与减低、异常与正常的受试者工作特征（ROC）曲线。采用Pearson分析法分析甲弥甲亢组、甲弥甲减组VI与甲状腺功能的相关性。

VI、Vascularity均为甲弥甲亢组>甲弥甲减组>甲弥甲功正常组>健康对照组，且任意两组间比较差异均有统计学意义（VI：健康对照组与甲弥甲亢组、甲弥甲减组、甲弥甲功正常组比较，q=13.67、7.00、3.93，P均<0.01；甲弥甲功正常组与甲弥甲亢组、甲弥甲减组比较，q=10.35、P<0.01，q=3.27、P<0.05；甲弥甲减组与甲弥甲亢组比较，q=7.09，P<0.01；Vascularity：健康对照组与甲弥甲亢组、甲弥甲减组、甲弥正常组比较，q=15.23、10.16、6.58，P均<0.01；甲弥甲功正常组与甲弥甲亢组、甲弥甲减组比较，q=9.33、3.83，P均<0.01；甲弥甲亢组与甲弥甲减组比较，q=5.55，P<0.01）。ROC曲线显示，VI鉴别诊断甲状腺弥漫性病变患者甲状腺功能亢进与减低的阈值为9.526%，敏感度为70.0%，特异度为76.5%，曲线下面积为0.733。VI鉴别诊断甲状腺弥漫性病变患者甲状腺功能异常与正常的阈值为7.404%，敏感度为62.5%，特异度为88.9%，曲线下面积为0.768。Pearson相关分析结果显示，甲弥甲亢组患者VI与血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）浓度呈正相关（r=0.584、0.499，P均<0.05），与血清促甲状腺激素浓度呈负相关（r=-0.447，P<0.05）；甲弥甲减组患者VI与FT4浓度呈负相关（r=-0.342，P<0.05），与FT3、TSH浓度无相关性（r=0.121、-0.007，P均>0.05）。

CFA技术能量化甲状腺实质内的血流信号，对甲状腺弥漫性病变患者甲状腺功能评估有一定的应用价值。

To evaluate the value of color flow angio (CFA) in judging the status of thyroid function by analyzing the ultrasonographic features and quantitatively measuring the blood flow signals in patients with thyroid diffuse lesions.

Totally 100 patients with thyroid diffuse lesions diagnosed by ultrasonography between Oct. 2016 and Jun. 2017 were divided into three groups: hyperthyroidism group (n=30), hypothyroidism group (n=34) and euthyroid group (n=36). Moreover, 30 cases of healthy volunteers were chosen as control group. The blood flow index including vascularity index ( VI ) value and Vascularity value of region of interest from all cases was measured through CFA imaging technique. The differences of VI and Vascularity from above 4 groups were compared using one-way analysis of variance. Comparison among groups was carried out by SNK-q test. The subjects′ work curves (ROC curves) were plotted and analyzed using clinical diagnosis as gold standard. At the same time, the correlation between VI and thyroid function in hyperthyroid group and hypothyroidism group was analyzed through Pearson correlation coefficient.

The levels of VI and Vascularity in hyperthyroid group, hypothyroid group, euthyroid group and control group were decreased gradually with significant differences between every two groups. VI : control vs hyperthyroid, hypothyroid and euthyroid group: q=13.67, 7.00 and 3.93, all P<0.01. Euthyroid vs hyperthyroidism and hypothyroid group: q= 10.35, P<0.01 and q=3.27, P<0.05. Hyperthyroidism vs hypothyroid group: q=7.09, P<0.01. Vascularity: control vs hyperthyroid, hypothyroid and euthyroid group: q=15.23, 10.16 and 6.58, all P<0.01. Euthyroid vs hyperthyroidism and hypothyroid group: q=9.33 and 3.83, both P<0.01. Hyperthyroidism vs hypothyroid group: q=5.55, P<0.01. The area under the curve of hyperthyroidism group and hypothyroidism group was 0.733, with 9.526% as the diagnostic cutoff point. The sensitivity and specificity were 70.0% and 76.5% respectively. The area under the curve of the abnormal group and normal group was 0.768, with 7.404% as the diagnostic cutoff point. The sensitivity and specificity were 62.5% and 88.9%, respectively. The VI value of hyperthyroidism group was positively correlated with FT3 and FT4 (r=0.584, 0.499, both P<0.05), and negatively correlated with TSH (r=-0.447, P<0.05). The VI value of hypothyroidism group was negatively correlated with FT4 (r=-0.342, P<0.05), and had no significant correlation with FT3 and TSH (r=0.121, -0.007, P>0.05).

CFA imaging technology can quantitatively measure the blood flow signals of thyroid parenchyma and evaluate the thyroid function in patients with thyroid diffuse lesions.