摘要
目的探讨细针穿刺细胞学（FNAC）检查和甲状腺自身抗体检测在桥本甲状腺功能亢进（甲亢）与Graves病（GD）鉴别诊断中的临床应用价值。方法本组资料362例中有3例因样本细胞数量少而未能诊断，根据FNAC分型将359例甲亢患者分为桥本甲亢组119例、GD—Ⅰ组（间质淋巴细胞浸润〈10％）162例、GD-Ⅱ组（淋巴细胞浸润10％～20％）49例、GD-Ⅲ组（淋巴细胞浸润20％～40％）29例，观察4组甲状腺自身抗体及甲状腺激素水平的差异。结果FNAC发现淋巴细胞破坏上皮细胞以及退行性变和（或）嗜酸性变的滤泡上皮细胞时仅见于桥本甲亢组，为其特征性表现。GD—I、Ⅱ、Ⅲ3组FNAC检查可见淋巴细胞数量依次呈增加趋势，而滤泡上皮细胞增生呈降低趋势；3组平均血清甲状腺球蛋白抗体（TGAb）分别为（43．5±29．0）％、（61．3±24．4）％、（68．9±22．3）％，而平均甲状腺微粒体抗体（TMAb）分别为（38．0±26．1）％、（54．7±23．0）％、（60．8±22．7）％，与GD—I组相比，GD-Ⅱ、GD—Ⅲ组升高均有显著性差异（P〈0．05）；3组的促甲状腺激素受体抗体（TRAb）水平分别为（57．7±71．0）U／L、（31．5±62．1）U／L、（21．2±47．0）U／L，与GD—I组相比，GD-Ⅱ、GD—m组显著降低（P〈0．01）。桥本甲亢组TGAb、TMAb均值显著高于GD—Ⅰ组（P〈0．01），而TRAb、游离T，（FT3）、游离T4（FL）均值显著低于GD—Ⅰ组（P〈0．01）；桥本甲亢组与GD-Ⅱ、Ⅲ组相比，各抗体均值差异均无统计学意义（P〉0．05）。GD—Ⅲ组病史均值显著长于其他3组（P〈0．01），而其他3组间差异无显著性（P〉0．05）。结论FNAC对鉴别桥本甲亢与GD各型具有重要的临床价值。血清TRAb、TGAb、TMAb水平对鉴别桥本甲亢与GD—Ⅰ型有-定临床价值，而对鉴别桥本甲亢与GD-Ⅱ型、Ⅲ型临床意义不大。
Objective To discuss the values of the fine-needle aspiration cytology （FNAC） and the measurement of the thyroid auto-antibodies in differentiating Hashimoto＇s hyperthyroidism （HILT） from Graves＇ disease（GD）. Methods 3 FNAC specimens of 362 patients with hyperthyroidism were inadequate for diagnosis. The other 359 patients were divided into four groups based on the FNAC typing：119 cases of HHT, 162 cases of GD-Ⅰ,49 cases of GD-Ⅱ,29 cases of GD-Ⅲ. The differences in the levels of thyroid globin antibody （TGAb）, thyroid nficrosome antibody （TMAb）, and thyroid stimulating hormone receptor antibody （TRAb） as well as free thyroid hormones （FT3, FT4 ） in the above four groups were investigated. Results The destroyed and metamorphic follicle-like epithelia were the characteristic pattern of FNAC in the group of HHT. In the groups of GD-Ⅰ, Ⅱand Ⅲ, with the increasing of the numbers of lymphocytes infiltration and the decreasing of the epithelia hyperplasia, the average levels of TGAb [ （43.5 ± 29.0） %, （61.3 ± 24.4） %, （68.9 ± 22. 3 ） % ] and TMAb [ （38.0 ±26. 1）% ,（54.7±23.0）% ,（60.8±22.7）% ] showed an ascending tendency in turn while the average levels of TRAb[ （57.7 ±71.0）U/L,（31.5 ±62.1）U/L,（21.2 ±47.0）U/L], FT3 and FT4 showed a descending tendency. The average levels of TGAb and TMAb in the HHT group were higher than those in the GD-Ⅰ group （P 〈 0.01 ）, while the average levels of TRAb, FT3 and FT4 were lower than those in the GD-Ⅰ group （P 〈0.01 ）. The differences in all the autoantibodies above between HHT group and the groups of GD-Ⅱ and GD-Ⅲ were not significant （P 〉0.05）. The average duration of the diseases in the GD-B group was longer than that of the other groups （P 〈0.01 ）,while there was no significant differences of the average duration in the other groups （P 〉 0.05 ）. Conclusion FNAC has an important clinical value in differentiating HHT from GD-I,II and m, while the serum levels of TRAb, TGAb and TMAb have some clinical value in this differentiation from GD-Ⅰ but have little clinical value to differentiate HHT from GD-Ⅱ and Ⅲ.
出处
《国际内分泌代谢杂志》
2010年第2期76-79,F0003,共5页
International Journal of Endocrinology and Metabolism
