亚急性甲状腺炎患者的血清指标变化与细胞病理学特征  

Alteration of serum profile and its correlation with cytopathological features in subacute thyroiditis

作　　者：叶廷军[1] 袁勤[1] 施新明[1] 樊绮诗[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院检验科,上海200025

出　　处：《诊断学理论与实践》2009年第4期401-404,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的:探讨亚急性甲状腺炎(SAT)患者血清指标变化与细胞病理学的内在关系。方法:本实验选取116例研究病例,包括76例SAT患者、30例桥本甲状腺炎(HT)患者及10名正常对照者。用微粒子酶免化学发光分析法检定外周血中甲状腺激素及甲状腺自身抗体指标。细胞病理学检查,行细针穿刺抽取病变组织,涂片做HE染色,光镜检查。所有研究对象均行血沉(ESR)、血常规检查。结果:SAT组患者的FT3、FT4高于正常组和HT组的检测值(P<0.05),其均值分别为(14.52±2.51)pmol/L、(35.32±5.61)pmol/L;TSH高于HT组(P<0.05),均值为(2.72±0.81)mIU/L;甲状腺球蛋白抗体(TGAb)、TpoAb低于HT组(P<0.05),其均值分别为(0.32±0.05)IU/mL、(251.32±86.81)IU/mL。SAT组细胞病理特征以炎症细胞、淋巴细胞及多核巨细胞。HT为广泛的淋巴细胞浸润,滤泡上皮细胞嗜酸性变和萎缩等特点。两组甲状腺滤泡上皮中的淋巴细胞计数结果为:HT组的各型淋巴细胞计数均高于SAT组(P<0.05)。HT组ESR和NE均为正常,而SAT组的ESR和中性粒细胞(NE)高于HT组(P<0.05)。在SAT组中弥漫浸润型组织中的淋巴细胞少于肉芽肿型和纤维化型(P均<0.05)。结论:SAT其血清学特征为TGAb、TpoAb一般不出现持续升高状态而FT3、FT4、TSH水平则会出现升高。细胞病理学表现为多核巨细胞和肉芽肿改变。了解SAT血清指标与细胞病理学变化,对于诊断和鉴别诊断SAT有重要意义。Objective To investigate the correlation between serum profile and cytopathological features in patients with subacute thyroiditis （SAT）. Methods One hundred and sixteen cases including 76 patients with SAT, 30 patients with Hashimoto＇s thyroiditis （HT） and 10 normal controls were enrolled in the study. Serum levels of FT3, FT4, TSH, TGAb and TpoAb were determined by mieroparticle enzyme immunoassay （MEIA）. Cytology examinations were performed by fine needle aspiration biopsy and H＆E stain and light microscopy observation. Erythrocyte sedimentation rate （ESR） and blood routine examination were also performed. Results The levels of FT3[（14.52±2.51） pmol/L]and FT4 [（35.32±5.61） pmol/L] in patients with SAT were significantly higher than those in controls （P〈0.05）. The level of TSH [（2.72±0.81） mIU/L] in patients with SAT was significantly higher than that in HT patients （P〈0.05）. While the levels of TGAb[（0.32±0.05） IU/mL] and TpoAb[（251.32±86.81） IU/mL] were significantly lower in patients with SAT than that in HT patients （P〈0.05）. The cytological feature in SAT showed inflammatory cells, lymphocytes and muhinueleated giant cells. While the HT showed extensive lymphocytic infiltration, eosinophilie degeneration of follicular epithelial cells and atrophy. The lymphocyte count in HT was obviously higher than that in SAT （P〈0.05）. ESR and NE value in SAT were significantly higher than that in HT （P〈0.05）. In SAT, the lymphocyte count in diffuse infiltrative subtype was lower than that in granuloma subtype or fibrosis subtype （P〈0.05）. Conclusions Serum profile of SAT showed recurrent high levels of FT3, FT4 and TSH, while sustained elevation of TGAb and TpoAb was not generally seen. Cytological feature of SAT showed muhinucleated giant cells and granuloma. Understanding the serum profile and cytopathological feature of SAT is important for the diagnosis and differential diagnosis of SAT.

关 键 词：亚急性甲状腺炎 甲状腺激素 自身抗体 细胞病理 

分 类 号：R581.4[医药卫生—内分泌] R361[医药卫生—内科学]