摘要
目的探讨亚急性甲状腺炎（SAT）的核医学分型诊断及其临床价值。方法获取得到病理和（或）临床随访结果的169例首次甲状腺^99mTcO4-静态显像（TSI）诊断为SAT患者和36例对照者的血清游离三碘甲状腺氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、抗甲状腺球蛋白抗体（TGA）、抗甲状腺微粒体抗体（TMA）资料；根据TSI提示的甲状腺的放射性分布、甲状腺与唾液腺的摄^99mTcO4-比值K及血清TSH将SAT分为ⅠA、ⅠB、ⅡA、ⅡB、ⅢA、ⅢB、ⅣA、ⅣB型；Ⅰ、Ⅱ型给予糖皮质激素治疗，ⅢA给予水杨酸制剂治疗，ⅢB型辅以甲状腺片短期治疗，内科治疗后残留较大结节者和ⅣB型予以手术治疗；随访观察12—36个月。结果①SAT总体上并无典型的“低K低TSH、高F13高FT4”的“分离现象”，仅70．4％的Ⅰ、Ⅱ型患者呈现典型的“分离现象”。②92．9％的SAT患者有不同程度的边界模糊征象，Ⅲ型（14．29％）明显低于Ⅰ、Ⅱ、Ⅳ型（100％）（x^2≥37．29，P〈0．01）。③SAT的TGA、TMA的阳性率仅为7．1％，与Ⅰ、Ⅱ、Ⅲ、Ⅳ型（分别为7．04％、6．25％、14．29％、5．6％）比较差异无统计学意义（x^2≤1．51，P〉0．05）。④6．25％的Ⅱ型（3／48）为甲状腺癌，明显高于其他类型（0／121）（x^2=4．53，P〈0．05）。⑤仅29．0％的患者临床首诊为SAT；TSI易将Ⅲ型SAT误诊为Graves病，误诊率（85．7％）明显高于其他类型（1．9％）（x^2=101．31，P〈0．01）；以病理和（或）临床随访结果为标准，TSI诊断AST的灵敏度、特异度和准确率分别为92．8％、90．9％、94．0％；结合临床和血清甲状腺激素水平考虑，灵敏度、特异度和准确率上升到100％、90．9％、98．5％。⑥72．8％的患者预后大致正常，8．9％的患者出现永久性甲状腺功能低下；64例；临床首诊为甲状腺腺瘤的SAT患者中33例内科治疗后结节消失或明显缩小，仅31例残留较大结节需要手术治疗。结论核医学检查诊断SAT的准确性较高，分型诊断对指导SAT治疗方案的选择、疗效评价和预后预测具有重要的临床价值。
Objective To study the nuclear medicine classificatory diagnosis of subacute thyroiditis（SAT） and its clinical value. Methods The datas of serum FT3, FT4, TSH, TGA, TMA were acquired in 169 patients with SAT diagnosed by fist ^99mTcO4 - static imaging（TSI） and 36 compare subjects simultaneously. According to the thyroid radionuclide distribution,the thyroid/salivary gland ratio（K） and serum TSH,the SAT was classified to Ⅰ A, Ⅰ B, Ⅱ A, Ⅱ B, ⅢA, ⅢB, ⅣA and ⅣB. Types Ⅰ , Ⅱ A and Ⅱ B types were treated with glucocorticoid, ⅢA with salicylate, ⅢB with short stage thyrotherapy. The SAT complicating node after medical treatment and Ⅳ B types were operated. All cases were followed - up 12 - 36 months. Results （1）There was no typical feature of separated phenomenon for serum FT3 and FT4 increased above normal, K and serum TSH below normal in 169 SAT cases as a whole. The typical features of separated phenomenon was only found in 70.4% of Ⅰ and Ⅱ types.（2）The blurry feature of thyroid edge in different degree was found in 92.9% SAT, the sign of Ⅲ types（ 14.29% ） was more lower than Ⅰ , Ⅱ and Ⅳ types（ 100% ） （X^2 ≥37.29, P 〈0.01 ）, respectively. （3）The positive ratios of serum TGA and TMA was 7. 1% , there were no significant difference among Ⅰ （ 7.04% ）, Ⅱ （ 6.25 % ）, Ⅲ types （ 14.29% ） and Ⅳtypes （5.6%） （ x^2 ≤ 1.51, P 〉 0.05 ）, respectively. （4）Thyrocarcinoma was confirmed in 6.25 % of H types SAT, the ratios was more higher than other types （0） （ X2 = 4.53, P 〈 0.05 ）. （5） Only 29.0% cases were firstly diagnosed with SAT. Ⅲ types were easy misdiagnosed with Graves＇ disease easily by TSI, the misdiagnosis ratio（85.7% ） was more higher than other types（ 1.9% ） （ x^2 = 101.31, P 〈 0. 01 ）. According to pathological results, the sensitivity, specificity and accuracy of TSI for SAT was 92.8% ,90.9% and 94.0% , respectively. Linking with the clinical symptom （features） and serum TSH, TGA and TMA, the sensitivity, specificity and accuracy were 100% ,90.9% and 98.5% ,respectvely. （6）72.8% SAT recovered well. Permanent hypothyroidism was found in 8.9% cases. Thyrophyma was the first complaint in 64 cases, the nodes were minified significantly or disappeared in 33 cases （51.6%） ,the remaining nodes were operated only in 31 cases（48.4% ）. Conclusions Nuclear check is a higher accurate method in diagnosing SAT. The nuclear medicine classificatory diagnosis could play an important role on selecting therapeutic programs, evaluating therapeutic efficiency and predicting the prognosis in SAT.
出处
《中国实用医刊》
2009年第13期16-20,共5页
Chinese Journal of Practical Medicine
关键词
亚急性甲状腺炎
锝
放射性核素显像
分型诊断
治疗
评价
Subacute thyroiditis
Technetium, radionuclide imaging
Classificatory diagnosis
Treatment
Assessment
