白癜风患者血清免疫球蛋白、补体、自身抗体检测及分析

目的 检测白癜风患者血清中免疫球蛋白IgG、IgA、IgM,补体C3、C4,抗核抗体(ANA)、抗甲状腺过氧化物酶抗体(A-TPO)、抗甲状腺球蛋白抗体(A-TG)的水平并进行比较分析.方法 收集门诊确诊为白癜风的患者血清168例和正常体检人群血清88例,性别、年龄分布无统计学差异,采用速率散射比浊法检测白免疫球蛋白IgG、IgA、IgM和补体C3、C4,采用ELISA法检测抗核抗体,采用电化学发光免疫分析法检测A-TPO、A-TG,结果用SPSS19.0统计软件进行分析.结果 白癜风患者组血清中免疫球蛋白IgG、IgA、IgM,补体C3、C4表达水平与正常人对照组差异不具有统计学意义(P＞0.05);白癜风组与正常对照组ANA阳性率分别为8.1％和5.7％,经比较差异不具有统计学意义(P＞0.05);两组间A-TPO的阳性率分别为18.8％和10.2％,差异有统计学意义(P＜0.05);两组A-TG阳性率分别为25.8％和4.5％,经比较差异具有统计学意义(P＜0.01).结论 部分白癜风患者存在体液免疫紊乱,在发病机制上可能与自身免疫性甲状腺疾病有相似之处;免疫球蛋白、补体及抗核抗体等免疫指标的检测在白癜风诊治中评价的意义不大.     

A multi-analyte immunoassay for thyroid related analytes

We describe the development and validation of multianalyte immunoassays (MAIA) for three analytes, viz., thyroxine (T4), thyroid stimulating hormone (TSH), and thyroglobulin (Tg) essential for assessment of thyroid function but having widely varying molecular weights. Using polycarbonate (PC) track-etched membranes (TEM) as an immobilization support and ¹²⁵I as the tracer, both competitive assay for T4 and non-competitive assay for TSH and Tg were performed on the same TEM. MAIA was found to be highly sensitive and precise with clinically useful working range and correlated very well with individual analyte immunoassays. While we have demonstrated this assay format with radiotracer, it can be used with non-isotopic tracers equally well.     

细针穿刺细胞学检查联合细针穿刺洗脱液甲状腺球蛋白在评估乳头状甲状腺癌转移性淋巴结中的价值

目的 探讨细针穿刺细胞学检查联合细针穿刺洗脱液甲状腺球蛋白在评估乳头状甲状腺癌转移性淋巴结中的价值。方法分析了我院甲状腺乳头状癌患者136例(153个淋巴结)的临床资料。根据病理结果分为转移组42例(74个淋巴结)和无转移组48例(79个)。分析在FNA-Tg≤1.0ng/ml或≤1.0ng/ml时,两组有或无淋巴结转移的比例是否有差异。比较US-FNA、FNA-Tg以及联合法诊断转移性淋巴结的敏感性、特异性和准确性。分析符合1、2、3、≥4个可疑转移性淋巴结超声征象时,采用US-FNA或联合法判断转移淋巴结的敏感性、特异性及准确性。结果 转移组的FNA-Tg>1.0ng/ml的淋巴结比例明显高于非转移组(X2=85.416 P=0.000)。判断转移性淋巴结采用联合法(91.9%)、FNA-Tg(90.5%)的敏感性高于单独使用US-FNA(70%)(P<0.05);联合法的特异性(97.5%)和准确性(94.8%)高于US-FNA(88.6%,79.7%)或是FNA-Tg(83.5%,86.9%)(P<0.05),而US-FNA和FNA-Tg之间的特异性和准确性无统计学意义(P>0.05)。当符合1个、2个超声征象时,联合法诊断转移性淋巴结的敏感性(80%、90%)、准确性(88%、92.9%)均高于US-FNA(敏感性：46%、60%;准确性：74%、76.2%)(P<0.05),但特异性之间无明显差异(P>0.05)。当符合3个超声征象时,采用US-FNA或联合法判断淋巴结是否转移的敏感性、特异性及准确性之间均无明显差异(P>0.05)。当符合≥4个超声征象时,采用US-FNA或联合法判断转移淋巴结的敏感性、特异性及准确性均为100%。结论 对于具有1或2个可疑淋巴结超声征象的乳头状甲状腺癌患者,联合US-FNA和FNA-Tg检测可以提高诊断的准确性,值得在临床工作中合理应用。     

Iodine and thyroid status during pregnancy and risk of stillbirth: A population-based nested case–control study

Prior research suggests that severe iodine deficiency in pregnancy may be associated with stillbirth. However, the relationship between mild to moderate iodine insufficiency, which is prevalent even in developed countries, and risk of stillbirth is unclear. We thus examined associations of iodine status and risk of stillbirth in a prospective population-based nested case–control study in Finland, a mild to moderately iodine insufficient population. Stillbirth cases (n = 199) and unaffected controls (n = 249) were randomly selected from among all singleton births in Finland from 2012 to 2013. Serum samples were collected between 10 and 14 weeks gestation and analysed for iodide, thyroglobulin (Tg) and thyroid-stimulating hormone (TSH). Odds ratios (ORs) and 95% confidence intervals (CIs) for stillbirth were estimated using logistic regression. After adjusting for maternal age, prepregnancy body mass index, socio-economic status and other factors, neither high nor low serum iodide was associated with risk of stillbirth (Q1 vs. Q2–Q3 OR = 0.92, 95% CI = 0.78–1.09; Q4 vs. Q2–Q3 OR = 0.78; 95% CI = 0.45–1.33). Tg and TSH were also not associated with risk of stillbirth in adjusted models. Maternal iodine status was not associated with stillbirth risk in this mildly to moderately iodine-deficient population. Tg and TSH, which reflect functional iodine status, were also not associated with stillbirth risk. The lack of associations observed between serum iodide, TSH and Tg and risk of stillbirth is reassuring, given that iodine deficiency in pregnancy is prevalent in developed countries.     

放射免疫分析法相关参数对甲状腺球蛋白检测结果的影响

目的评价放射免疫分析法曲线拟合方式一定时,不同试剂盒、结合率方式(B/T与B/B0)对甲状腺球蛋白(TG)检测结果的影响。方法选用国内具有代表性的3家放射免疫试剂盒(A、B、C组),分别对78例临床确诊的甲状腺疾病患者血清TG进行检测。曲线拟合方式一定前提下,分别用B/T与B/B0 2种结合率方式进行检测,分析3家放射免疫试剂盒的不同结合率方式对检查结果的影响。结果 A、B、C组试剂盒检测TG值差异有统计学意义(z=6.11,P0.05);A组与B组检测TG值差异无统计学意义(z=0.894,P0.05);A组与C组检测TG值差异有统计学意义(z=2.01,P0.05);B组和C组检测TG值差异也有统计学意义(z=1.963,P0.05)。在B/T与B/B0 2种结合率方式下,A组和B组检测TG值差异均无统计学意义(P0.05),C组检测TG值差异有统计学意义(z=-1.68,P0.05)。结论曲线拟合方式一定,选择不同的放射免疫试剂盒必须选择其试剂盒所对应的结合率方式,才能得出较准确的TG检测结果。     

Malignant struma ovarii: The west of Scotland experience and review of literature with focus on postoperative management

Introduction: Malignant struma ovarii is an extremely rare ovarian tumour containing malignant thyroid carcinoma within differentiated thyroid tissue, as the predominant tissue type. Surgery for suspected ovarian tumour and incidental pathological diagnosis is the most common presentation. Evidence supporting any particular approach to the clinical management of this condition is limited, mainly consisting of case reports, small series or pathological case series. There is no randomised evidence for postoperative management in view of the rarity of this condition. The opinion is divided between conservative management versus total thyroidectomy and radio‐iodine ablation. Methods: We carried out a retrospective review of our series with focus on postoperative management of this rare condition. A review of existing literature was also carried out. Results: Six patients with a median age of 52 years presented with various symptoms of abdominal pain, pressure or menstrual problems. After the initial gynaecological resection and specialised pathology review, they were subsequently treated with total thyroidectomy and administration of radioactive iodine. All of these six patients are in remission at a median follow up of 60 months. Conclusion: We favour aggressive postoperative management with total thyroidectomy and radioactive iodine, and long‐term follow up of these patients.     

Detection of circulating Tg-mRNA in the follow-up of papillary and follicular thyroid cancer: how useful is it?

To investigate the usefulness of thyroglobulin mRNA (Tg-mRNA) detection in peripheral blood in the follow-up of papillary and follicular (differentiated) thyroid cancer, a literature study was performed. Both evidence for and evidence against the usefulness of Tg-mRNA detection were found. Also, evidence for the expression of Tg-mRNA in cells other than normal or neoplastic thyroid follicular cells was found. It is concluded that currently Tg-mRNA detection is not a useful tool in the follow-up of differentiated thyroid carcinoma, but that the concept of using RT-PCR measurements during follow-up still warrants further research.     

Mixed Medullary-follicular Thyroid Carcinoma： Report of a Case and Review of the Literarture

Mixed medullary-follicular carcinomas （MMFCs） are tumors of the thyroid that display morphological and immunohistochemical features of both medullary and follicular neoplasms. These tumors are rare and less than 40 cases have been described in the literature since the early 1980s The term medullary-follicular thyroid carcinoma denotes a tumor which exhibits the features of a medullary carcinoma and shows positive expression of calcitonin on immunohistochemistry. It is a follicular-derived thyroid carcinoma and is positive for thyroglobulin expression within the same tumor. Most reported cases have lymph node involvement at the time of diagnosis. In cases having disease progression, distant metastases develop in the lung, liver, mediastinum and bone. We report a case of a male patient with mixed medullary-follicular thyroid carcinoma and a review of the literature.