Application of Thyroid Function Indicators Combined with Transcranial Doppler Ultrasound and Carotid Ultrasound in the Assessment of Vascular Stenosis in Atherosclerotic Cerebral Infarction
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摘要:
目的 探究甲状腺功能指标[促甲状腺激素（thyroid stimulating hormone，TSH）、游离甲状腺素（free thyroxine，FT4）、游离三碘甲状腺原氨酸（free triiodothyronine，FT3）]联合经颅多普勒超声（transcranial doppler ultrasound，TCD）及颈动脉超声对动脉粥样硬化性脑梗死（atherosclerotic cerebral infarction，ASCI）血管狭窄的评估价值，为临床针对性治疗提供参考。 方法 选取2021年10月至2023年9月邯郸市第一医院收治的182例ASCI患者，均行TCD、颈动脉超声及甲功三项检查，以数字减影血管造影术为金标准，分析TCD、颈动脉超声联合TSH、FT4、FT3对ASCI血管狭窄的评估作用。 结果 182例ASCI患者经数字减影血管造影（digital subtraction angiography，DSA）证实颈内动脉血管轻度狭窄64例（35.16%），中度狭窄69例（37.91%），重度狭窄29例（15.93%），完全闭塞20例（10.99%）。不同血管狭窄程度各组临床资料比较差异无统计学意义（P > 0.05）；不同血管狭窄程度各组颈内动脉收缩期最大流速（peak systolic velocity，PSV）、舒张末期流速（end-diastolic volume，EDV）随着血管狭窄程度加重呈升高趋势，搏动指数（pulse index，PI）、阻力指数（resistance Index，RI）、管径（diameter，D）随着血管狭窄程度加重呈降低趋势（P < 0.05）；不同血管狭窄程度各组TSH、FT4随着血管狭窄程度加重呈升高趋势，FT3随着血管狭窄程度加重呈降低趋势（P < 0.05）；TSH、FT4与血管狭窄程度呈正相关，FT3与血管狭窄程度呈负相关（P < 0.05）；TSH、FT4与PSV、EDV呈正相关，与RI、PI、D呈负相关，FT3与RI、PI、D呈正相关，与PSV、EDV呈负相关（P < 0.05）；RI、PI、D、PSV、EDV、TSH、FT4、FT3联合评估ASCI血管狭窄程度的AUC值最大，为0.941（P < 0.05）。 结论 TCD、颈动脉超声联合甲功三项对ASCI颈内血管狭窄评估有较高价值，RI、PI、D、PSV、EDV、TSH、FT4、FT3联合评估有利于诊断不同程度血管狭窄，为临床提供治疗参考。 -
关键词:
- 动脉粥样硬化性脑梗死 /
- 经颅多普勒超声 /
- 颈动脉超声 /
- 促甲状腺激素 /
- 游离甲状腺素 /
- 游离三碘甲状腺原氨酸 /
- 血管狭窄
Abstract:Objective To explore the evaluation value of thyroid function indicators [thyroid stimulating hormone （TSH）, free thyroxine （FT4）, free triiodothyronine （FT3）] combined with transcranial Doppler ultrasound （TCD） and carotid ultrasound in the assessment of vascular stenosis in atherosclerotic cerebral infarction （ASCI）, providing a reference for clinical targeted treatment. Methods A total of 182 patients with ASCI admitted to Handan Frist Hospital from October 2021 to September 2023 were selected and all of them underwent TCD, carotid artery ultrasound and thyroid function examination. Digital subtraction angiography was used as the gold standard to analyze the evaluation effect of TCD and carotid artery ultrasound combined with TSH, FT4 and FT3 in vascular stenosis of ASCI. Results Among the 182 patients with ASCI, DSA confirmed 64 cases（35.16%） with mild internal carotid artery stenosis, 69 cases（37.91%） with moderate stenosis, 29 cases（15.93%） with severe stenosis, and 20 cases（10.99%） with complete occlusion. There was no statistically significant difference in clinical data among groups with different degrees of vascular stenosis （P > 0.05）. The peak systolic velocity （PSV） and end-diastolic volume （EDV） of the internal carotid artery in different groups with different degrees of vascular stenosis showed an increasing trend with the severity of vascular stenosis, while the pulse index （PI）, resistance index （RI）, and diameter （D） showed a decreasing trend （P < 0.05）. In different groups with different degrees of vascular stenosis, TSH and FT4 levels increased with the severity of stenosis, while FT3 levels decreased （P < 0.05）. TSH and FT4 were positively correlated with the degree of vascular stenosis, while FT3 was negatively correlated（P < 0.05）. TSH and FT4 were positively correlated with PSV and EDV, and negatively correlated with RI, PI, and D. FT3 was positively correlated with RI, PI, and D, and negatively correlated with PSV and EDV （P < 0.05）. The combined evaluation of RI, PI, D, PSV, EDV, TSH, FT4, and FT3 yielded the highest area under the curve （AUC） value of 0.941 for assessing ASCI vascular stenosis （P < 0.05）. Conclusion The combination of TCD, carotid ultrasound, and thyroid function tests have high value in the assessment of ASCI vascular stenosis. The joint evaluation of RI, PI, D, PSV, EDV, TSH, FT4 and FT3 is beneficial for diagnosing different degrees of vascular stenosis, providing a reference for clinical treatment. r clinical treatment. -
图 1 A TCD联合、颈动脉超声单独及联合评估ASCI血管狭窄程度的ROC曲线
Figure 1. A ROC curves for combined TCD and carotid ultrasound，individual and combined assessment of ASCI vascular stenosis
图 2 B甲功三项单独及联合、TCD、颈动脉超声、甲功三项联合评估ASCI血管狭窄程度的ROC曲线
Figure 2. B ROC curve for assessing the degree of vascular stenosis in ASCI using individual and combined thyroid function tests，TCD，and carotid ultrasound.
表 1 不同血管狭窄程度ASCI患者临床资料比较[（$ \bar x \pm s $）/n（%）]
Table 1. Comparison of clinical data of ASCI patients with different degrees of vascular stenosis [（$ \bar x \pm s $）/n（%）]
资料 轻度狭窄组（n = 64） 中度狭窄组（n = 69） 重度狭窄组（n = 29） 完全闭塞组（n = 20） χ2/F P 性别 1.506 0.681 男 29（45.31） 36（52.17） 15（51.72） 12（60.00） 女 35（54.69） 33（47.83） 14（48.28） 8（40.00） 年龄（岁） 63.58 ± 4.09 62.29 ± 4.16 64.11 ± 3.92 62.72 ± 4.02 1.848 0.140 体质量指数（kg/m2） 23.18 ± 1.17 22.96 ± 1.43 23.48 ± 1.21 23.32 ± 1.29 1.248 0.294 发病至就诊时间（h） 3.72 ± 0.63 3.86 ± 0.72 3.75 ± 0.69 3.91 ± 0.75 0.685 0.563 高血压 27（50.00） 36（57.97） 22（72.41） 16（75.00） 6.455 0.092 高脂血症 25（39.06） 33（47.83） 17（58.62） 14（60.00） 4.512 0.211 糖尿病 16（25.00） 20（28.99） 13（44.83） 11（45.00） 5.486 0.140 饮酒 13（20.31） 16（23.19） 11（37.93） 9（45.00） 7.109 0.071 吸烟 10（15.63） 12（17.39） 7（24.14） 7（35.00） 4.211 0.240 
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表 2 不同血管狭窄程度ASCI患者超声相关参数、甲功三项比较（$ \bar x \pm s $）
Table 2. Comparison of ultrasound related parameters and thyroid function test in ASCI patients with different degrees of vascular stenosis （$ \bar x \pm s $）
资料 轻度狭窄组（n = 64） 中度狭窄组（n = 69） 重度狭窄组（n = 29） 完全闭塞组（n = 20） χ2/F P TCD参数 RI 0.60 ± 0.02 0.59 ± 0.03a 0.56 ± 0.03ab 0.51 ± 0.02abc 70.732 < 0.001* PI 0.92 ± 0.03 0.86 ± 0.05a 0.74 ± 0.04ab 0.70 ± 0.03abc 229.374 < 0.001* 颈内动脉超声参数 D（mm） 4.83 ± 1.06 3.79 ± 0.97a 3.15 ± 0.82ab 2.63 ± 0.74abc 37.855 < 0.001* PSV（cm/s） 171.68 ± 51.94 226.45 ± 63.67a 323.86 ± 78.92ab 0.00 ± 0.00abc 128.582 < 0.001* EDV（cm/s） 56.76 ± 8.64 85.38 ± 20.21a 147.85 ± 43.10ab 0.00 ± 0.00abc 207.157 < 0.001* 甲功三项 TSH（mIU） 7.22 ± 0.61 9.24 ± 0.98a 12.85 ± 1.36ab 13.91 ± 1.68abc 320.630 < 0.001* FT4（pmol/L） 15.41 ± 1.03 17.10 ± 1.99a 18.13 ± 2.45ab 19.84 ± 2.72abc 33.191 < 0.001* FT3（pmol/L） 2.25 ± 0.58 1.97 ± 0.43a 1.67 ± 0.26ab 1.45 ± 0.23abc 21.083 < 0.001* *P < 0.05；与轻度狭窄组对比，aP < 0.05；与中度狭窄组对比，bP < 0.05；与重度狭窄组对比，cP < 0.05。
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表 3 超声相关参数与甲功三项的相关性分析
Table 3. Correlation analysis of ultrasound parameters and thyroid function tests
超声相关参数 TSH FT4 FT3 r P r P r P TCD参数 RI −0.637 < 0.05 −0.606 < 0.05 −0.613 < 0.05 PI −0.704 < 0.05 −0.582 < 0.05 0.642 < 0.05 颈动脉超声参数 D −0.643 < 0.05 −0.624 < 0.05 0.588 < 0.05 PSV 0.716 < 0.05 0.701 < 0.05 −0.631 < 0.05 EDV 0.683 < 0.05 0.634 < 0.05 −0.592 < 0.05
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表 4 轻中度、重度与完全闭塞ASCI患者超声相关参数、甲功三项比较（$ \bar x \pm s $）
Table 4. Comparison of ultrasound parameters and thyroid function tests in ASCI patients with mild to moderate，severe，and complete occlusion （$ \bar x \pm s $）
资料 轻中度狭窄（133例） 重度狭窄与完全闭塞（49例） t P TCD参数 RI 0.59 ± 0.02 0.54 ± 0.03 12.956 < 0.001* PI 0.89 ± 0.06 0.72 ± 0.05 17.691 < 0.001* 颈内动脉超声参数 D（mm） 4.29 ± 1.15 2.94 ± 0.89 7.433 < 0.001* PSV（cm/s） 200.09 ± 65.18 323.86 ± 78.92 10.716 < 0.001* EDV（cm/s） 71.61 ± 22.64 147.85 ± 43.10 15.456 < 0.001* 甲功三项 TSH（mIU） 8.27 ± 1.21 13.28 ± 1.80 21.537 < 0.001* FT4（pmol/L） 16.29 ± 2.38 18.83 ± 2.94 5.981 < 0.001* FT3（pmol/L） 2.10 ± 0.62 1.58 ± 0.33 5.580 < 0.001* *P < 0.05。
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表 5 TCD、颈动脉超声、甲功三项单独及联合评估ASCI血管狭窄程度的效能
Table 5. Efficacy of TCD，carotid ultrasound，and thyroid function tests in assessing ASCI vascular stenosis individually and in combination
指标 AUC 95%CI 截断值 敏感度（%） 特异度（%） P RI 0.755 0.686～0.816 0.58 77.55 68.42 < 0.05 PI 0.750 0.681～0.812 0.78 75.51 65.41 < 0.05 TCD联合 0.853 0.793～0.901 12.13 71.43 85.71 < 0.05 D 0.784 0.717～0.841 3.99 mm 75.51 74.44 < 0.05 PSV 0.764 0.695～0.823 267.8 cm/s 77.55 61.65 < 0.05 EDV 0.743 0.673～0.804 158.48 cm/s 63.27 79.70 < 0.05 颈动脉超声联合 0.873 0.815～0.917 12.18 83.67 81.20 < 0.05 TSH 0.810 0.745～0.864 12.69 mIU 79.59 76.69 < 0.05 FT4 0.787 0.720～0.844 16.51 pmol/L 79.59 66.17 < 0.05 FT3 0.741 0.671～0.803 2.12 pmol/L 71.43 66.92 < 0.05 甲功三项联合 0.871 0.813～0.916 14.03 79.59 87.22 < 0.05 TCD、颈动脉超声、甲功三项联合 0.941 0.896～0.970 12.73 89.80 87.22 < 0.05
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表 6 ROC曲线对比
Table 6. Comparison of ROC curve
成对对比 AUC差异 标准误差 95%CI Z P TCD联合VS TCD、颈动脉超声、甲功三项联合 0.088 0.035 0.019～0.157 2.512 0.012 颈动脉超声联合VS TCD、颈动脉超声、甲功三项联合 0.068 0.034 0.002～0.135 2.020 0.043 甲功三项联合VS TCD、颈动脉超声、甲功三项联合 0.073 0.037 0.002～0.145 2.002 0.045
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