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投稿时间：2025-11-27 网络发布日期：2026-07-30
投稿时间：2025-11-27 网络发布日期：2026-07-30
中文摘要: 目的 探讨桥本甲状腺炎抗体阳性期与进展至亚临床甲状腺功能减退（甲减）阶段的超声表现及血清学变化特征，分析抗体滴度与甲状腺超声特征之间的相关性及变化趋势，评估超声指标在不同疾病阶段中的诊断价值。方法 回顾性纳入2023 年至2024 年在辽宁省人民医院甲乳外科就诊并完成相关检查者作为研究对象，收集其一般资料、甲状腺血清学指标［促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、甲状腺过氧化物酶抗体（TPOAb）、抗甲状腺球蛋白抗体（TgAb）］和甲状腺超声检查结果（包括低回声、边缘不规则、回声不均匀、血流信号增加和网格样高回声五个特征）。根据甲状腺血清学检测结果，将研究对象分为仅抗体阳性组（n=101）、亚临床甲减组（n=74）和对照组（n=51）。采用Spearman 相关分析抗体与超声特征的相关性。采用多因素logistic 回归分析筛选亚临床甲减的独立影响因素。基于logistic 回归分析结果建立预测模型，绘制受试者工作特征（ROC）曲线并评估超声诊断疾病效能。结果 三组低回声、回声不均匀、血流信号增加、边缘不规则和网格样高回声五个超声特征差异均有统计学意义（P<0.05）。TPOAb和TgAb抗体滴度与低回声、边缘不规则、回声不均匀、血流信号增加和网格样高回声这五项甲状腺超声特征均呈正相关（P<0.05）。多因素logistic 回归分析显示，发生亚临床甲减的影响因素包括低回声（OR=0.043，95%CI：0.014~0.132，P<0.01）和网格样高回声（OR=5.824，95%CI：2.101~16.140，P<0.01）。联合超声指标预测亚临床甲减的AUC为0.843，灵敏度为0.797，特异度为0.762。结论 低回声和网格样高回声两项超声特征对早期识别桥本甲状腺炎进展至亚临床甲减具有良好价值。
中文关键词: 桥本甲状腺炎 亚临床甲状腺功能减退症 抗体 超声 甲状腺过氧化物酶抗体 抗甲状腺球蛋白抗体
Abstract:Objective To investigate the ultrasound features and serological changes in patients with Hashimoto 's thyroiditis（HT）during the antibody-positive stage and after progression to subclinical hypothyroidism，to analyze the correlation and trend between antibody titers and thyroid ultrasound characteristics，and to evaluate the diagnostic value of ultrasound indicators at different disease stages. Methods Study subjects were retrospectively enrolled from patients who visited Liaoning Provincial People's Hospital and completed relevant examinations between 2023 and 2024. General data，thyroid serological indices［thyroid-stimulating hormone，free triiodothyronine，free thyroxine，thyroid peroxidase antibody（TPOAb），and anti-thyroglobulin antibody（TgAb）］，and thyroid ultrasound findings（including five features：hypo-echogenicity，irregular margins，heterogeneous echotexture，increased blood flow signal，and mesh-like hyper-echogenicity）were collected. Based on thyroid serology，participants were divided into three groups：antibody-positive only group（n=101），subclinical hypothyroidism group（n=74），and control group（n=51）. Spearman correlation analysis was used to assess the correlation between antibody titers and ultrasound features. Multivariate logistic regression was performed to identify independent factors for subclinical hypothyroidism. A predictive model was established based on the logistic regression results，and the diagnostic performance of ultrasound features was evaluated using receiver operating characteristic（ROC）curves. Results Significant differences were observed among the three groups in all five ultrasound features：hypo - echogenicity，heterogeneous echotexture，increased blood flow signal，irregular margins，and mesh-like hyper-echogenicity（P<0.05）. TPOAb and TgAb titers were positively correlated with these five ultrasound features（P<0.05）. Multivariate logistic regression showed that the factors influencing the development of subclinical hypothyroidism were hypo-echogenicity（OR=0.043，95%CI：0.014-0.132，P<0.01）and mesh-like hyper-echogenicity（OR=5.824，95%CI：2.101-16.140，P<0.01）. The combination of ultrasound indicators yielded an AUC of 0.843 for predicting subclinical hypothyroidism，with a sensitivity of 0.797 and a specificity of 0.762.Conclusion The ultrasound features of hypo-echogenicity and mesh-like hyper-echogenicity have good value for early identification of progression from Hashimoto's thyroiditis to subclinical hypothyroidism.
keywords: Hashimoto's thyroiditis Subclinical hypothyroidism Antibody Ultrasound Thyroid peroxidase antibody Anti-thyroglobulin antibody
文章编号： 中图分类号：R581 R445.1 文献标志码：A
基金项目:辽宁省科学技术厅应用基础研究计划项目（2022JH2/101300026）；新疆生产建设兵团第十师北屯市科技局课题 （2022-179-03）；中国高校产学研创新基金?中康联临床医学专项（2025ZK005）
附件
| Author Name | Affiliation |
| CHEN Xuanyu*，SUN Yihan，LIU Daming，ZHU Liangliang，CUI Jianchun，JU Xing'ai | *Graduate School of Jinzhou Medical University,Jinzhou,Liaoning 121001,China |
引用文本：
陈宣聿,孙溢晗,刘大铭,等.超声特征对桥本甲状腺炎进展至亚临床甲状腺功能减退的预测效能[J].中国临床研究,2026,39(7):1048-1051,1056.
陈宣聿,孙溢晗,刘大铭,等.超声特征对桥本甲状腺炎进展至亚临床甲状腺功能减退的预测效能[J].中国临床研究,2026,39(7):1048-1051,1056.