超声对桥本甲状腺炎的诊断及误诊分析

<正>桥本甲状腺炎(Hashimoto′s thyroiditis,HT)又称慢性淋巴细胞性甲状腺炎。1912年Hashimoto在4例甲状腺瘤中发现并首先报道,是一种自身免疫病,是甲状腺炎中最常见的一种[1]。由于该病发展隐匿,临床表现无特异性,早期诊断较为困难。近年来,随着彩色多普勒高频超声技术的发展,对HT的诊断有了显著进展。本文通过对     

超声对慢性淋巴细胞性甲状腺炎合并结节分类评估的价值

<正>慢性淋巴细胞性甲状腺炎(chronic lymphomatosa thyroiditis)又称为桥本甲状腺炎(Hashimoto′s thyroiditis,HT),属于自身免疫病,成年女性最常见,起病隐匿,常合并不同性质结节。文献[1,2]报道HT患者中发现甲状腺结节相当普遍,但桥本病的超声实质背景表现复杂,超声对HT合并恶性结节的术前诊断率较低,文献报道为10%~40%。本文回顾性分     

自身免疫性甲状腺疾病相关肾病二例

自身免疫性甲状腺疾病(Autoimmune Thyroid Disease,AITD)包括Graves病、甲状腺炎和原发性甲状腺功能低下(甲减),其伴有蛋白尿并不少见,甚至少数患者伴肾病综合征,合并肾脏损害被称为AITD肾病。近年甲状腺炎和原发性甲状腺功能低下导致肾病国内外陆续有报道,Graves病引起     

桥本甲状腺炎48例超声影像分析

<正>桥本甲状腺炎(Hashimoto’s thyroiditis,HT)是较常见的自身免疫性甲状腺疾病。本文笔者总结了所在医院2006-01～2008-05收治的48例HT的超声影像资料,旨在探讨超     

自身免疫性甲状腺病的研究进展

自身免疫性甲状腺病（AITD）是一组常见的器官特异性自身免疫性疾病,但其发病机制尚未完全明了,其临床表现复杂容易误诊。目前认为细胞因子、细胞凋亡、微量元素和遗传或易感因素等可能参与了AITD发生过程。本文就此展开综述。     

桥本甲状腺炎的中医药治疗研究进展

桥本甲状腺炎(Hashimoto′s thyroiditis,HT)是一种与甲状腺有关的自身免疫性疾病,发病率在逐年增高。中医药治疗桥本甲状腺炎具有较大优势:缓解甲状腺肿大,降低甲状腺自身免疫性抗体、调节机体本身的免疫、延缓病情等。该研究对近年来桥本甲状腺炎的中医药治疗研究进展进行综述。     

抗甲状腺抗体在自身免疫性甲状腺疾病中的作用

摘要：自身免疫性甲状腺疾病（AITD）以桥本甲状腺炎（HT）和Graves病（GD）最为常见,常伴有抗甲状腺抗体阳性,本文综述了抗甲状腺抗体的基本特征及其在AITD免疫过程及诊断中的作用。     

Grave病相关肾病5例临床分析

目的探讨自身免疫性甲状腺疾病（AITD）相关肾病发病机制及临床病理特点。方法通过5例患者的诊治结合文献对该病进行综合分析。结果AITD肾病以蛋白尿为主，少数表现为肾病综合征和。肾炎综合征，病理表现多样化以膜性肾病、系膜增生性肾小球肾炎、局灶性肾小球硬化为主。结论治疗甲状腺疾病的同时加用免疫抑制剂效果良好。     

碘在自身免疫性甲状腺疾病中的作用及其机制探讨

碘是人体必需的微量元素，是合成甲状腺激素的主要成分，人体所需的碘通过饮食和饮水提供．食物提供的碘几乎占所需碘的90％以上，但部分地区仍有碘缺乏病。近年来，随着世界性补充碘剂防治碘缺乏病（IDD）工作的开展，IDD得到了有效控制，而各种甲状腺疾病包括Grave＇s病、桥本氏甲状腺炎（HT）、原发性甲状腺功能减退症等自身免疫性甲状腺疾病（AITD）及碘致甲状腺机能亢进症（IIH）发病有明显增加的趋势．而且病程延长，复发率增加，甲状腺机能亢进症的病因学类型有所改变。大量的流行病学调查证实了补碘与AITD的发病存在密切关系。本文将有关方面的进展进行综述。     

血清瘦素水平检测对自身免疫性甲状腺疾病的临床意义

目的为了探讨自身免疫性甲状腺疾病（AITD）血清瘦素（Lep）水平变化与甲状腺激素及能量代谢之间关系。方法对158例AITD患者用放射免疫分析法（RIA）测定Lep、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、甲状腺球蛋白抗体（TGA）和甲状腺微粒体抗体（TMA）;用免疫放射分析法（IRMA）测促甲状腺激素（TSH）;用放射受体分析法（RRA）测促甲状腺激素受体抗体（TRAb）及常规测量体重指数（BMI）,并取38例甲状腺功能正常体检者作对照。结果AITD甲减组Lep明显低于对照组（P〈0.01）、AITD甲亢组BMI低于AITD甲减组（P〈0.05）。在对照组、AITD甲亢组、AITD甲减组、AITD甲功正常组中Lep水平皆与BMI呈显著正相关（r分别为0.52、0.48、0.50、0.55）AITD甲减组Lep于FT4相关（r=0.31,P〈0.05）;与TSH负相关（r=-0.39,P〈0.05）。结论甲状腺激素的不同变化可影响Lep的正常调节及能量代谢。     

自身免疫性甲状腺疾病患者血清肿瘤坏死因子的研究

采用放免法检测Graves病（GD）和桥本氏甲状腺炎（HT）患者血清肿瘤坏死因子（TNF）含量。结果显示；GD未治组、GD缓解组和HT组血TNF浓度均显著高于对照组；GD缓解组TNF水平明显低于GD未治组及HT组。提示自身免疫性甲状腺疾病（AITD）患者体内存在细胞因子的异常，TNF的变化可能是AITD发生发展的重要原因。     

甲状腺疾病粗针穿刺活检病理与临床诊断对比

总结５４例甲状腺粗针穿活检病例，分析其病理、超微病理改变与临床诊断和实验检查的联系。结果表明，活检成功率为９２．６％，病理确诊率为９０．７％，活检前临床诊断与病理符合率仅为６７．３％。三分之一左右临床诊断为Ｇｒａｖｅｓ甲亢的患者实为甲亢伴甲状腺炎或桥本甲亢。超微病理检查对自身免疫性甲状腺疾病的鉴别诊断有较大价值。２０％以上的桥本甲状腺炎和桥本甲亢患者自身抗体ＴｇＡｂ、ＴＭＡｂ测定结果呈阴性。     

自身免疫性甲状腺疾病活检病理分析

分析自身免疫性及非自身免疫性甲状腺疾病共52例患者的病理改变，并与临床诊断和实验室检查进行比较。结果显示活极成功率为93．0％，病理诊断率91．2％，活检前临床诊断与病理符合率68．4％。较多临床诊断为Graves病的患者实为甲亢伴甲状腺炎或桥本甲亢。电镜检查对自身免疫性甲状腺疾病的鉴别诊断有较大价值。部分桥本甲状腺炎或桥本甲亢患者自身抗体TgAb和TMAb测定呈阴性结果。     

Hepatitis B vaccine and risk of autoimmune thyroid disease: a Vaccine Safety Datalink study

PURPOSE: Hepatitis B vaccine has been postulated as a possible cause of autoimmune disorders, including autoimmune thyroid diseases (ATD). Cases of Graves' disease and Hashimoto's thyroiditis, following hepatitis B vaccine have been reported to the Vaccine Adverse Events Reporting System (VAERS). To test the hypothesis that hepatitis B vaccine increases the risk of ATD, we conducted a case-control study, within the Vaccine Safety Datalink project. METHODS: We identified potential cases of Graves' disease and Hashimoto's thyroiditis, among persons aged 18-69 years from administrative data recorded by three health maintenance organizations (HMOs) and verified cases by medical record review. Controls were frequency-matched to cases by birth year, sex, and study site. Vaccine information was collected from administrative records, chart review, and telephone interviews with study subjects. We enrolled 355 Graves' disease cases, 418 Hashimoto's thyroiditis cases, and 1102 controls. We assessed the association between ever-receipt of hepatitis B vaccine, as well as receipt of hepatitis B vaccine less than 1 year, 1-5 years and at least 5 years prior to the index date, and the risk of ATD. RESULTS: Ever-receipt of hepatitis B vaccine was not associated with risk of Graves' disease (odds ratio (OR), 0.90; 95% confidence interval (CI), 0.62-1.32) or Hashimoto's thyroiditis (OR, 1.23; 95%CI, 0.87-1.73). There was also no association between the time interval since receipt of hepatitis B vaccination and either outcome. CONCLUSIONS: We did not observe an increased risk of Graves' disease or Hashimoto's thyroiditis, following receipt of hepatitis B vaccine.     

CDFI在甲状腺疾病诊断中的临床应用价值探讨

目的探讨CDFI在甲状腺疾病诊断中的临床应用价值。方法笔者所在医院2006年1月～2010年6月应用CDFI检查甲状腺疾病132例,总结分析常见的甲状腺疾病如甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示情况。结果 132例中经病理或实验室确诊124例,超声诊断符合率93.9%。甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示各具特点。结论 CDFI能清晰显示甲状腺病变的大小、位置、囊实性变等,彩色多普勒超声及CDFI的应用提高了对甲状腺疾病的诊断率。     

自身免疫性甲状腺疾病实验室诊断

目的：采用TPOAb、TGb、FT3、FT4五项指标对自身免疫性甲状腺疾病（AITD）提供诊断和鉴别诊断的实验室依据。方法：采用放射免疫（受体）分析法测量165例AITD患者血清中TPOAb、TGAb、TRAb、FT3、FT4水平。结果：桥本甲状腺炎组TPOAb和TGAb升高与Graves病组、桥本甲亢组比较差异有显著性（P〈0．001）；TRAb、FT3、FT4正常与Graves病组、桥本甲亢组结果差异有显著性（P〈0．001）；Graves组和桥本甲亢组TRAb、FT3、FT4升高差异无显著性（P〉0．05），而TPOAb和TGAb结果升高差异有显著性（P〈0．001）。结论：上述五项实验室指标对AITD诊断、鉴别诊断及治疗原则、方法的选择具有重要意义。     

甲状腺过氧化物酶抗体的临床应用

甲状腺疾病是一组比较复杂的内分泌疾病,用于该疾病检测的实验室项目也日益增多,今天我们主要讨论甲状腺过氧化物酶抗体在我院临床诊断甲状腺类疾病的应用。甲状腺过氧化物酶（TPO）是位于甲状腺上皮细胞的顶端细胞膜上,直接参与甲状腺细胞中的氧化酪氨酸的碘化及碘化酪氨酸的偶联等。它是甲状腺激素合成过程中的关键酶。TPO 也是自身免疫性甲状腺疾病的(AITD)一种重要的自身抗原,可以刺激机体免疫系统产生TPO抗体（TPO-Ab）。TPO-Ab作为AITD一种主要的自身抗体,可通过激活补体,抗体依赖细胞介导的细胞毒作用和致敏的T杀伤细胞直接杀伤等作用机制,引起甲状腺滤胞损伤,间接的抑制甲状腺的合成,导致甲状腺功能减退的主要机制。所以TPO-Ab水平的检测是诊断AITD的一项不可缺少的实验室指标。     

Evaluation of thyroid gland function in children with obstructive apnea hypopnea syndrome

Patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and thyroid function abnormalities, such as hypothyroidism and Hashimoto's thyroiditis, usually have closely resembling clinical features. Differentiation between these disorders is made more difficult because hypothyroid patients are also at risk for secondary sleep-disordered breathing. The aim of our study is to evaluate the prevalence of thyroid function abnormalities in children with OSAHS. Forty-four children (15 females: 29 males), 2.5-14.5 (7.43±2.98) years old were studied with overnight polysomnography. Biochemical screening of thyroid gland function was also carried out. Patients were judged to have OSAHS based mainly on the evaluation of Apnea Hypopnea index per hour of sleep (AHI). 15/44 (34.1%) children had mild OSAHS, 17/44 (38.6%) moderate and 12/44 (27.3%) severe OSAHS. Hypothyroidism was recorded only in 5/44 (11.4%) and Hashimoto's thyroiditis in 3/44 (6.8%) of OSAHS patients. Two patients with hypothyroidism showed mild and three severe OSAHS, while from the 3 children with Hashimoto's thyroiditis one presented mild, one moderate and one severe degree of OSAHS. Although the majority of studies in bibliography worldwide do not consider necessary the systemic evaluation of thyroid gland function in patients with breathing disorders during sleep, it seems that in children this type of screening is required for the differential diagnosis between primary sleep apnea and hypothyroid sleep-disordered breathing in order to differentiate these two conditions. Therefore, the laboratory investigation of thyroid gland function could be considered necessary.     

Modifications of the immune responsiveness in patients with autoimmune thyroiditis: evidence for a systemic immune alteration

Hashimoto's thyroiditis, the most common form of autoimmune thyroid disease, is characterised by lymphocytic infiltration of the thyroid gland, gradual destruction of the organ and production of thyroid specific auto antibodies (antithyroid peroxidase and antithyroglobulin antibodies). There are evidences that cast doubt on the pathogenetic role of these antibodies in thyroid autoimmunity. It is very likely that cellular destruction is mediated by other cellular mechanisms, such as auto reactive T-lymphocytes, natural killer and cytokines. However, other studies performed in animal models have led to the conclusion that organ specific autoimmune thyroiditis should be regarded as a polygenic disease with a penetrance that is strongly influenced by environmental factors. According to our recent results, patients affected by autoimmune thyroiditis exhibited a decreased percentage of NK and CD25 + bearing cells significantly in comparison to normal controls. Altogether these data indicated that in the patients with autoimmune thyroid disease a certain degree of peripheral immune deficiency was present.