桥本甲状腺炎T细胞的免疫分型及其临床意义

目的:对3型桥本甲状腺炎(Hashimoto thyroiditis, HT)进行T细胞免疫分型,并分析其与滤泡损害程度的相关性,为临床诊治提供依据.方法:对136例细针穿刺(fine needle aspiration biopsy, FNAB)HT标本进行组织学观察并分型(L、P、O型),检测各型患者血清学指标(TPOAb、TGAb、TSH),以20例非毒性甲状腺肿作对照.对其中60例、23例FNAB HT标本分别进行免疫组织化学染色及流式细胞术检查,比较各型HT组织T淋巴细胞浸润程度及CD3 、CD4 、 CD8 T细胞分布情况.分析HT组织滤泡萎缩程度与T淋巴细胞浸润程度及分型的相关性.结果: FNAB组织学观察发现L型(n=58)、P型(n=28)滤泡萎缩程度比O型(n=20)严重(P＜0.05).免疫组化结果显示:L、P、O型HT组织T细胞表达率分别为 45%～60%、30%～50%、18%～35%.流式细胞术检测HT组织L型CD3 、CD4 、CD8 T细胞表达率分别为47%～67%、22%～38%、17%～27%;P型分别为34%～36%、16%～18%、11%～13%;O型分别为 33%～45%、16%～24%、12%～18%.L型滤泡萎缩程度与淋巴细胞浸润呈正相关(r=0.067),而O型 (r=-0.29)、P型 (r=-0.29)均与淋巴浸润呈负相关.结论:对FNAB标本进行T淋巴细胞免疫分型能直观反映HT变化程度,有助于临床诊治.

T cell immune phenotyping in patients with Hashimoto thyroiditis and its significance ?

Objective:To study the phenotypes of T cell in patients with Hashimoto thyrioditis (HT) and to analyze its relationship with the impairment of follicles, so as to provide evidence for clinical diagnosis and treatment. Methods: Totally 136 HT specimens were obtained by fine needle aspiration biopsy (FNAB) and were divided morphologically(L, P, O type). The serum parameters (TPOAb, TGAb, TSH) were tested, and 20 cases with nontoxic goiter were taken as control. Immuno-histochemical assay was performed with 60 specimens and FCM (Flow cytometry ) was used to study 23 specimens. The T cell infiltration and the distribution of CD3+ . CD4+ . and CD8+ T cells were compared between all types of HT tissues. The correlationship between the atrophic degree of follicle with T lymphocytes infiltration and phenotype was analyzed. Results: It was found that L type (n = 58) and P type (n = 28) had more serious follicle atrophy than that of O type (n = 20) (P<0. 05). Immuno-histochemical assay showed that the average expression rate of T cells were 45%-60% for L type, 30%-50% for P type,and 18%-35% for O type. FCM results showed that the T cell marker ratio were: for L type, CD3+ 47%-67%,CD4+ 22%-38%,CD8+ 17%-27%; for P type, CD3+ 34%-36%, CD4+ 16%-18%,CD8+ 11%-13%; for O type , CD3+ 33%-45%, CD4+ 16%-24% ,CD8+ 12%-18%. In L type, the follicle atrophic degree was positively correlated to lymphocyte infiltration level (r=0. 067); however, O type (r= -0. 29) and P type (r= -0. 29) were both negative correlated to it. Conclusion: Phenotyping of T cells in FNAB specimens can directly reflect the changing degree of HT, which is helpful for clinical diagnosis and treatment.