TCNCYH Phu truung 80 (3) - 2012
XAC DINH THt TICH TUY^N GIAP BANG SIEU AM 2D d BENH NHAN BASEDOW Nidi PHAT HIEN
VO Bich Nga', Bang ThuyAnhf 'Trudng Dai hpc Y Hi Npi, 'Benh vien Ndi tiit Trung Irang
Siiu im xic dinh cic kich thudc vi thi tich tuyin giip d nhOng binh nhin Basedow mdi phit hiin; tim mil liin quan giu'a thi tich tuyin giip vdi dd to cua budu giip, ning di FT4, TRAb d nhOng binh nhin Basedow mdi phit hiin. Kit qui nghiin c&u cho thiy thi tich tuyin giip trung binh d binh nhin Basedow li 20.51 ±11,20 ml Idn han ngudi binh thudng ii 8,92 ± 2,69 mi (p < 0,05): cd mil tuang quan tuyin tinh thuin chiiu giO'a thi tich tuyin giip vi ning dd FT4, TRAb
Tt> khia; Tuyin giip, b^nh Basedow, siiu am tuyin giip, thi tich tuyin giip, FT4, TRAb
\. DAT V A N Dt.
Basedow l i mpt trong s i cac benh nil tiit thudng g i p d Vipt Nam cung nhu tren t h i gidi. Bpnh nhin dupe chin d o i n sdm va diiu trj dCing se khoi hoin toan, ngupc lai co t h i t u vong do cac biin chdng Cac phuong tipn chin doan hinh anh tuyin giap dpc bipt la sieu i m 2D vdi d i u do t i n s i cao vdi nhung uu diem vupt troi dong vai tro quan trpng g i p phin vao chin d o i n xac dmh, Iua chon phuong phip dieu tri hiiu qua benh Basedow. Viec x i c djnh t h i tich tuyin giip chinh xac d i e biet c6 y nghTa trong dinh hudng Iua chon phuong phip diiu tri bpnh Basedow, trong viec tinh liiu I " ' khi diiu trj binh Basedow bang phuong phap lode phing xp. Ben canh do, theo doi t h i tich tuyen giip giup danh g i i hipu qua sau diiu trj bang lode phong xa d bpnh nhin Basedow.
lUuc tiiu:
Mo ta die diem the tich tuyin giip a benh nhan Basedow mai phat hien.
Phan tich moi lien quan giOa the tich tuyen giip vai cic trieu chung lam sang vi can lam sing khic tren benh nhan Basedow mai phat hidn.
II. B 6 | T U - O N G V A P H U ' a N G F ' H A P
1. D i i tup'ng v i phuang phip Nhdm chdng: 30 ngudi khoe mpnh.
Nhdm benh nhan Basedow: 44 benh nhan mdi duoc c h i n d o i n xac djnh bpnh Basedow kham va diiu trj tai khoa Npi tiit v i Oil thao dudng bpnh vipn Bach Mai t u thing 9/2009 d i n thing 4/2010. Loai tru c i c bpnh nhin co tiin su bl Basedow hoac c i c bpnh cudng giip khong phii Basedow.
Phuang phip nghien cuv: Mo ta, cat ngang.
2. Sieu i m tuyin giap
May sieu i m May sieu i m Philip HD3, dau do thing t i n s i 7,5 MHz.
Tu t h i bpnh nhin: Bpnh nhan nam ngi)a, CO udn t i l da, k i d giua vung ba vai va c^
bing mpt g i i nho d i y khoang 10 cm.
T i t ca c i c tuyin giap dupe tham do toan bp theo thd tu: thgy phai, thgy trii va eo tuyin tren c i c mpt cat ngang v i mat cat doc.
Yeu c i u : Oau do dat thing goc vdi co, phai liy dupe t o i n b i hinh anh cua 1 thuy hoac eo tuyin giip t r i n m i l mat cat.
Do cac kich thudc cua tdng thgy tuyin giap:
+ Chpn mpt cat ngang Idn nhit de *>
chiiu ring v i chiig sag t r i n cOng mpt mf..
TCNCYH Phu tnmng 80 (3) - 2012 cit. Chiig ring dupe do tren dudng thing
dai nhit di t u gidi han ngoai d i n gidi han trong cua thuy tgyin va chiiu sau dupe do tren dudng thing d i i nhit di t u gidi han trudc tdi gidi han sau d i n g thdi vuing goc vdi dudng thing do chiiu rpng d 1/3 giua.
+ Chpn mpt cat dpc d i i nhat d i do chiiu dii. Chiiu d i i l i khoang each giua diim d i u va diim cuii cua thgy tuyin.
Do cac kich thudc cOa eo tuyin- + Chpn mat cat ngang Idn nhit d i do chiiu rpng v i chiiu s i u t r i n ciJng mpt mpt cat. Chiiu rpng l i khoang cich gida hai dudng thing tudng tupng ke dpc theo bd ngoii hai ben khi quan. Chiiu s i u la
khoang cich trudc sau cua tuyin giip d chinh giua khi quan.
+ Chiiu dai eo tuyin dupe do tu diem gidi han tren va dudi cua eo tuyin khi dua d i u do dpc theo gida khi quan.
Dinh gia cac t i n thuong phoi hpp (niu c6).
T h i tich tgyin giap duoc tinh theo cong thdc cua GunterKunst.R
V = 0,479 • a • b * c
V: Thi tich 1 thuy (hoac eo) tuyin giap (ml).
J, b, c: Chiiu rang, chiiu diy, chiiu dii cua mdt thuy (hoac eo) tuyin giip (cm).
T h i tich toan tuyin giap bang ting the tich 2 thuy va eo tuyin giap.
III. K i T QUA
1. Dpc d i i m chung cua nhdm nghien cdu
Bang 1. Oac diem chui;^g cua nhdm n g h i i n cdu D i e d i i m Nhom chdng Nhom benh Tuoi trung binh 43,90 ±15,61 48,59 ±11,57
Cao nhit 70 >0,05
Thip nhit Nu Nam
24 20 10
27 29 15 2. Cdc kich thu'dc t u y i n giap xdc dinh bdng sieu am 2D
Bang 2. So sanh cdc kich thu'dc t u y i n gldp xdc dinh bang sieu am 2D d nhdm Basedow va nhdm chu>ng
T h i tich t u y i n Thuy phai ThCiy trai Eo Toin tuyin
g i i p Nhdm chdng
4,88 ±1,51 ml 4,04 ±1,26 mi 0,65 ± 0,34 ml 9,57 ±2,92 ml
Nhdm benh 11,76 ±7,64 ml
8,74 ± 4,36 ml 1,75 ±1,64 ml 26,20 ±14,88 ml
P
<0,05
<0,05
<0,05
<0,05 3. L i i n quan giu'a t h i tich tuyen giap vdi mdc do to cua b u d u giap, n i n g dp FT4 v i TRAb d benh n h i n Basedow m d i phat h i i n
ChCing tdi nhin thay co m i l tuong quan tuyin tinh ding biin tuong d i i chat vdi r = 0,528, c6 y nghTa thing ke vdi p < 0,01 giua t h i tich tuyin giap v i ning dp FT4; Khi the tich tuyin giap 93
TCNCYH Phu truung 80 (3) - 2012
cing Idn thi ning dp FT4 cing t i n g theo phuong trinh tuong quan y = 1,306 * x + 42,024.
FT4(l>morl)
Th^ tfch tuv^ri eldp (ml) Bliu d i 1. Tucng quan giO'a t h i tich tuyin giip va ndng d$ FT4
Thfi tich tuv^n Blip (ml) 60 00-
TPiAb rul-l.11
Bliu d i 2. Tucng quan gida t i n g t h i tich 2 thuy tuyin giap v i ning d$ TRAb T h i tich tuyin giip v i ning dp TRAb d bpnh nhin Basedow mdi phit hipn co m i i tuong quan tgyin tinh d i n g biin tuong d i i chat vdi r = 0,641, c o y nghTa thing kevdi p < 0,01, theo phuong trinh: y = 0,558 * x + 11,373.
IV. BAN LUAN
Dac diim chung cija nhdm nghiin cipu Nhom chdng: Tong s i ngudi trong nhdm Chung l i 30 ngudi, t g i i t h i p nhit la 24 t g i i ,
43,90 ± 15,61, trong do cd 10 nam (33,3S v i 20 n u (66,6%). Nhdm benh nhSn Basedow: T i n g s i ngudi trong nhdm bpntila 44 ngudi, t u i i t h i p nhit la 27 tuii, tuii'M"
nhit l i 71 t u i i , t g i i trgng binh l i 48,59,a
TCNCYH Phu tnmng 80 (3) - 2012 nd (65,9%). Bac d i i m ve tuoi gidi cua nhom
Chung v i nhdm benh nhan Basedow trong nghien cdu cua chung toi tuong t u nhu trong nghiin cdu cua Luong Linh Ha va cong su.
Trong nghien cuu nay khong co su khic bipt v i tuii va gidi giua nhom benh nhin Basedow mdi phit hiin va nhom chdng (p >
0,05). Diiu nay dam bao cho su so sinh cac thong s i sieu i m tgyin g i i p dupe chinh xac, khoa hpc.
Cac kich t h u d c t u y i n giap x i c dinh b i n g sieu am 2D
The tich c i c phin tuyin giap d nhom Chung: Thiiy phai la 4,88 ± 1,51 ml, thijy trii la 4,04 ± 1,26 ml, eo la 0,65 ± 0,34 ml, toan tuyin giip l i 9,57 ± 2,92 ml. T h i tich cic phin tuyin giip d nhdm binh nhin Basedow: Thiiy phai l i 11,76 ± 7,64 ml, thiiy trii la 8,74 ± 4,36 ml, eo l i 1,75 ± 1,64 ml, toan tuyin giip l i 26,20 ± 14,88 ml. So sanh giua hai nhom: Chiig d i i , chiig rpng, chiiu diy, t h i tich trung binh cOa m i l thiiy va eo tuyin giap d nhom bpnh n h i n Basedow Idn hon d nhdm chung cd y nghTa thing ke vdi p
< 0,05. Nhu viy, budu giip trong bpnh Basedow cd tinh chit lan toa. K i t qga niy hoin toan phii hpp vdi y van, vdi cac k i t qua nghiin cdu x i c djnh t h i tich tuyin giap khac bang sieu am, xa hinh, chup cat Idp vi tinh cua cac tac gia khac.
Bang 3. T h i tich tuyin giap d benh nhan Basedow xic djnh bang s i i u am 2D theo
mpt s i t i c gia
Tac g i i The tich tuyen
giap (ml) C.Kobev4cs[1](n = 38) 23,9 ± 14,5 Xiao - Ming Mao vi cs [41 24 40 ± 12 87
(n = 96) ' Luang Linh Ha va cs [2] (n 35 99 + 13 97
= 130) ' VQ Bich Nga va cs (n =44) 20,51 ±11,20
T h i tich tuyin giip trung binh a bpnh nhan Basedow trong nhdm nghien cuu nay thip hon cac t i c gia khac Tuy nhien t h i tich tuyin giip trung binh cua binh nhin Basedow trong nghien cdu nay g i n vdi k i t qua cua C.Kobe hon ca v i bing 1/2 t h i tich tuyin giap trung binh trong nghien cuu cua Luong Linh H i . D i i u nay c6 the ly giai do d i i tuong nghien cug cga chOng toi v i C.Kobe d i u la nhung benh nhan Basedow mdi phat hien, Luong Linh H i va cpng su nghien cuu trin c i c binh nhan Basedow khong dap ung vdi dieu trj npi khoa c6 chinh djnh diiu trj bang lode phong xp
Lien quan giua t h i tich tuyin giap vdi ning dp FT4 va TRAb d benh nhan Basedow mdi phit hien.
Chiing toi nhan thiy co m i i tuong quan tuyin tinh ding biin tuong doi chat vdi r = 0,528, CO y nghTa thing ke vdi p < 0,01 giua t h i tich tuyin giap va ning dp FT4: Khi t h i tich tuyin giap cang Idn thi ning dp FT4 cing tang theo phuong trinh tuong quan y = 1,306'•X+42,024.
T h i tich tgyin giip v i ning dp TRAb d bpnh nhan Basedow mdi phit hien co moi tuong qgan tuyin tinh ding biin tuong d i i chat vdi r = 0,641, co y nghla thing ke vdi p
< 0,01, theo phuong trinh: y = 0,558 * x + 11,373. Bieu do cd nghTa l i : khi TRAb cing cao thi tuyin giap co t h i tich cang Idn. Biiu nay phii hpp vdi co c h i benh sinh cua benh va cing chinh xac hon khi ning dp FT4, TFRAb v i t h i tich tuyin giap chua chju anh hudng cua qua trinh dieu tri do d i i tupng nghiin cuu l i nhirng benh nhin Basedow mdi phat hien.
V. KfiT LUAN
T h i tich trgng binh tuyin giap d benh nhin Basedow mdi phat hipn l i 20,51 ±11,20 ml.
95
TCNCYH Phu tnmng 80 (3) - 2012 Idn hon t h i tich trung binh tuyin giip ciia ngudi binh thudng la 8,92 ± 2,69 ml Su khic nhag cd y nghTa thing ke vdi p < 0,05.
T h i tich tgyin giap cang Idn thi ning d i FT4 cang cao theo phuong trinh tuong qgan tgyin tinh y = 1,306 * x + 42,024, vdi r = 0,528. Su tuong qgan n i y c i y nghTa thing k i vdi p < 0,01. Ning d i TRAb v i t h i tich tuyin giip cd m i i tuong quan tgyin tinh thgin tuong d i i chpt vdi r = 0,641 cd y nghTa thing ke vdi p < 0,01, phuong trinh tuong quan y = 0,558 * X + 11,373.
T A I LIEU THAM K H A O 1. C. Kobe, I. Weber, W. Eschner (2008).
Graves' disease and radioiodine therapy. Nu- clearmedicin 2008, 47: 53 -166.
2. Luang Linh Ha, IVIai Trong Khoa, Pham Minh Thong (2001). Nghiin cuu bang siig i m v i xp hinh tuyin giap tren benh nhin Basedow. D i tai khoa hpc nam 2001.
3. Paolo Vitti (2000). "Grey scale thyroic ultrasonography in the evaluation of patientf with Graves' disease". European Jounal ol endocrinology 2000; 142: 22 - 24.
4. Xiao - Ming Mao, Hui - Qin Li, Qian Li (2009). "Prevention of relapse of Graves' disease by treatment with an intrathyroid in- jection of dexamethasone". J Clin Endocrinol Metab, 94 (12): 4984-4991.
5. Mehraj Sheikh, Suhail A.R.Doi(2004), Technical observations on the assessment of thyroid volum by palpitation and ultrasonog- raphy. J Ultrasound Med 23: 261 - 266,.
6. Luigi Solbiati et al(2001). Ultrasound of thyroide, parathyroid gland and neck lymph nodes. Eur Radiol 11: 2411 -2424
7. Schiemann U, Gellner R (1999). Stand- ardized grey scale gitrasonography in Graves' disease' correlation to agtoimmgne actively.
Eur J Endocrinol, oct; 141 (4) 332 - 336.
Summary
DETERMINATION OF THYROID VOLUME BY 2D ULTRASONOGRAPHY IN NEWLY DIAGNOSED BASEDOW PATIENTS
Using ultrasonography to determine thyroid size and volume in newly diagnosed Basedow patients and the relationship between thyroid volgmes, sizes of goitre and FT4, TRAb blood lev- els in these patients. The resglts indicated that the mean thyroid volgme in Basedow patients was 20.51 ± 11.20 ml which was higher than normal subjects 8.92 ± 2.69 ml (p < 0.05); there was a direct relationship between thyroid volumes and FT4, TRAb blood levels.
Keywords: thyroid, Basedow, thyroid ultrasonography, thyroid volume, FT4, TRAb
