超声探测颈部Ⅵ区淋巴结对诊断桥本氏甲状腺炎的临床研究

目的 通过超声探测发现颈部VI区淋巴结，指导化学发光检测TG-Ab、TPO-Ab，从而探讨超声提示桥本氏甲状腺炎（Hashimoto''s thyroiditis，HT）的可靠性。方法 选择在我院行甲状腺超声检查并发现颈部VI区淋巴结患者108例，常规检测FT3、FT4、TSH、TPO-Ab、TG-Ab，当有感冒咽痛病史及甲状腺区疼痛患者需同时检测血沉（ESR）。怀疑恶性甲状腺结节患者需经手术证实。病例所有资料分成HT组和非HT组，对应VI区所显示的正常和异常淋巴结分析，同时将单纯HT（图像较均一，可有单发典型胶质结节）和声像较均一的单纯非HT对应正常与异常淋巴结另行回顾性分析。结果 不同致病因素所致颈部VI区显示淋巴结，无论HT组或非HT组，颈部VI区超声所显示淋巴结中异常淋巴结回声比例均较高，HT组占97.2%，非HT组占91.9%，相互间无统计学差异（χ²=0.577，P=0.448）。在排除亚急性甲状腺炎、甲状腺恶性肿瘤及炎性结节等其他声像图改变后，颈部VI区异常淋巴结对应的单纯HT组与单纯非HT组相互间有显著差异（χ²=6.126，P=0.013），超声显示颈部VI区异常淋巴结与临床诊断桥本氏甲状腺炎密切相关，诊断阳性符合率为96%。结论 所有致病因素致超声显示颈部VI区淋巴结中，基本为异常淋巴结回声。在排除其他较典型致病因素后，超声在颈部VI区发现异常淋巴结可以提示诊断桥本氏甲状腺炎。

CLINICAL STUDY OF ULTRASONIC DETECTION OF CERVICAL LYMPH NODES IN VI REGION FOR DIAGNOSIS OF HASHIMOTO'S THYROIDITIS

Objective: To investigate the ultrasound hint reliability of hashimoto''s thyroiditis (HT) through detecting lymph nodes in the neck region VI by ultrasound and guiding the chemiluminescence detection of tg-ab and tpo-ab. Methods: A total of 108 cases of patients with cervical lymph nodes in VI region were selected for thyroid ultrasound examination in our hospital. Routine tests were conducted for FT3, FT4, TSH, tpo-ab and tg-ab, and ESR should be tested in the patients with a history of cold pharyngeal pain and thyroid area pain. Patients with suspected malignant thyroid nodules should be confirmed by surgery. All the data of the cases were divided into HT group and non-HT group, corresponding to the analysis of normal and abnormal lymph nodes shown in region VI. Meanwhile, the retrospective analysis of normal and abnormal lymph nodes was carried out separately corresponding to the simple HT (relatively uniform images, with single typical colloid nodules) and simple non-HT (relatively uniform images). Results: There were no significant differences between the proportions of abnormal lymph node echo (97.2%) in the HT group and 91.9% in the non-HT group (x²=0.577, P=0.448). In the exclusion of subacute thyroiditis, thyroid malignant tumor, inflammatory nodules and other ultrasonographic changes, there were significant differences between the proportions of abnormal lymph node echo in the HT group and in the non-HT group (x²=0.577, P=0.448), the results of ultrasound showed the abnormal lymph nodes in the zone of neck VI is closely related to the clinical diagnosis of hashimoto''s thyroiditis, the positive diagnosis coincidence rate was 96%. Conclusion: The lymph nodes in region VI of the neck, which were caused by all pathogenic factors, were basically abnormal. In the exclusion of other more typical pathogenic factors, ultrasound findings of abnormal lymph nodes in the VI region of the neck may suggest the diagnosis of hashimoto''s thyroiditis.