桥本甲状腺功能亢进与Graves病鉴别诊断的临床观察

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-Ⅲ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_3(FT_3)、游离T_4(FT_4)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型有一定临床价值,而对鉴别桥本甲亢与GD-Ⅱ型、Ⅲ型临床意义不大.

Clinical investigations on differentiating Hashimoto's hyperthyroidism from Graves' disease

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), thy-roid microsome antibody (TMAb), and thyroid stimulating hormone receptor antibody (TRAb) as well as free thyroid hormones (FT_3, FT_4) in the above four groups were investigated.Results The destroyed and metamor-phic follicle-like epithelia were the characteristic pattern of FNAC in the group of HHT.In the groups of GD-Ⅰ, Ⅱ and Ⅲ, with the increasing of the numbers of lymphocytes infiltration and the decreasing of the epithelia hyperpla-sia, 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], FT_3 and FT_4 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,FT_3 and FT_4 were lower than those in the GD-Ⅰ group (P <0.01).The differ-ences 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-Ⅲ 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 Ⅲ, 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.