【摘要】：[目的]探討聲輻射力脈沖彈性成像(Acoustic radiation force impulse,ARFI)的聲觸診組織量化技術(shù)(Virtual touch tissue quantification, VTQ)與聲觸診組織成像量化技術(shù)(Virtual touch tissue imaging quantification,VTIQ)對妊娠早中期女性甲狀腺功能減低性疾病的應(yīng)用價值。[方法]選取2016年7月-2017年1月在我院就診的妊娠早中期甲狀腺功能減低癥患者65例作為總甲減組,參照2011年《妊娠和產(chǎn)后甲狀腺疾病診斷和處理:美國甲狀腺學(xué)會指南》,根據(jù)甲狀腺功能將總甲減組又分為甲減組及亞甲減組,其中甲減組15例,亞甲減組50例,另選取35例甲功正常的妊娠早中期女性作為對照組。使用Siemens Acuson Helx S3000型超聲診斷儀,配備VTQ及VTIQ技術(shù)軟件的9L4線陣探頭,觀察甲狀腺的大小、形態(tài)、回聲及測量甲狀腺上動脈的峰值流速(Peak systolic velocity ,PSV)及阻力指數(shù)(Resistance index,RI)再用VTQ條件測量甲狀腺右側(cè)葉的剪切波速度(Shear wave velocity, SWV),然后用VTIQ彩色模式(VTIQ-C)測量甲狀腺右側(cè)葉的SWV值,最后用VTIQ灰階模式(VTIQ-B)測量甲狀腺右側(cè)葉的SWV值。應(yīng)用SPSS21.0統(tǒng)計軟件進(jìn)行統(tǒng)計分析。[結(jié)果]1、甲減組、亞甲減組及對照組之間體積、PSV、RI差異均無統(tǒng)計學(xué)意義。2、正常妊娠早、中期VTQ模式下SWV值參考值范圍為1.88±0.36m/s, VTIQ模式下SWV參考值范圍為2.12±0.17m/s。3、VTQ模式下甲減組與對照組、亞甲減組與對照組及甲減組與亞甲減組之間的SWV值差異無統(tǒng)計學(xué)意義,VTQ模式下總甲減組與對照組之間差異有統(tǒng)計學(xué)意義(P=0.042)。VTIQ模式下甲減組與對照組之間差異有統(tǒng)計學(xué)意義(P=0.004),亞甲減組與對照組之間差異有統(tǒng)計學(xué)意義(P=0.045),甲減組與亞甲減組之間差異無統(tǒng)計學(xué)意義(P=0.253)。VTIQ模式下總甲減組與對照組之間差異有統(tǒng)計學(xué)意義(P0.0001)。4、VTQ與VTIQ兩種模式下的SWV值比較,對照組、亞甲減組差異均有統(tǒng)計學(xué)意義(均為P0.0001);甲減組差異無統(tǒng)計學(xué)意義(P=0.278);總甲減組差異有統(tǒng)計學(xué)意義(P0.0001)。在VTIQ-C與VTIQ-B模式下的SWV值比較,甲減組、亞甲減組及對照組均差異無統(tǒng)計學(xué)意義,P值分別約(0.313、0.161、0.191)。5.亞甲減組早孕期與中孕期VTQ及VTIQ兩種模式下的SWV值差異均無統(tǒng)計學(xué)意義(P0.05)。甲減組與亞甲減組中血清中TSH滴度與VTQ及VTIQ兩種技術(shù)所測的SWV值均無相關(guān)性。[結(jié)論]1、常規(guī)超聲對妊娠期甲狀腺減低性疾病的診斷特異性不明顯。2、本研究正常妊娠早、中期女性VTQ模式下SWV值參考值范圍為1. 88±0. 36m/s,VTIQ 模式下 SWV 參考值范圍為 2. 12±0. 17 m/s。3、ARFI的VTQ與VTIQ技術(shù)在對甲狀腺組織的軟硬度定量、定性評估上有一定價值。4、同一患者VTQ與VTIQ所測的SWV值有顯著統(tǒng)計學(xué)差異,是由于VTQ的局限性所致。5、VTIQ的灰階和彩色兩種模式測量得出的SWV值均比較穩(wěn)定,各有優(yōu)劣,可以互補(bǔ)。6、孕婦亞臨床甲狀腺功能減低癥SWV值不受妊娠孕周的影響。7、VTQ及VTIQ兩種模式下測得的妊娠期甲狀腺功能減低性疾病的SWV均與TSH滴度無相關(guān)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 鹵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 鹵0.161 鹵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 鹵0. The SWV reference range for 36 m / s / s VTIQ is 2. 5%. 12 鹵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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256;R445.1

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