桥本氏病45例临床误诊原因及对策

The factors and strategy of misdiagnosis of Hashimoto's disease (a 45 cases report).

目的总结桥本氏病(HD)的误诊原因,探讨防止误诊的对策。方法对45例术后病理证实为HD患者的临床资料进行回顾性分析。结果20例(44.4%,20/45)术前作免疫学检查,甲状腺球蛋白抗体(TGA)阳性率45%(9/20),甲状腺微粒体抗体(TMA)阳性率70%(14/20),促甲状腺激素(TSH)升高8例(40%,8/20);23例行B超检查,2例(8.7%,2/23)考虑HD;5例行穿刺细胞学检查,3例(60%,3/5)诊断为HD;21例(46.7%,21/45)行术中冰冻病理检查,19例(90.5%,19/21)与术后病理结果相符,术中误诊率57.8%(26/45)。10例术前拟诊HD,35例(77.8%,35/45)误诊为甲状腺其它疾病。术后病理诊断为单纯性HD24例,HD合并甲状腺其它疾病21例(46.7%,21/45)。结论HD容易误诊,结合免疫学、B超或穿刺细胞学检查可提高术前诊断率,术中冰冻病理检查是确诊HD及其合并病的有效方法。

Objective To conclude the factors of the misdiagnosis of Hashimoto's disease(HD) and to investigate the strategy. Methods The clinical data of 45 cases of HD which proved by postoperative pathology were analyzed retrospectively. Results 20 cases (44.4%, 20/45) were detected for immunology and the positive rate of thyroglobulin antibody (TGA) was 45%(9/20), and that of thyromicrosome antibody (TMA) was 70% (14/20), thyroid stimulating hormone(TSH) was upregulated in 8cases (40%,8/20). 23cases(8.7%,2/23) were checked by B sonarography and 2cases(8.7%,2/23) were prediagnosed of Hashimoto's disease. Fine needle biopsy was performed in 5cases and 3 cases(60%,3/5) were diagnosed of HD. Frozen pathologic check was performed in 21cases(46.7%,21/45) during operation and 19cases(90.5%,19/21) were confirmed by paraffin pathologic check, the rate of misdiagnosis during operation was 57.8%(26/45). 10cases were prediagnosed of HD before operation, 35cases(77.8%,35/45) were misdiagnosed of other thyroid disease. 24cases were diagnosed of simple HD after operation and 21 cases (46.7%,21/45) of HD concomitant with other thyroid diseases. Conclusion HD was susceptible to misdiagnosis. It can be diagnosed more correctly before operation through the detection of immunology combined with B sonarography or fine needle biopsy. Frozen pathologic check is effective to diagnose HD and its concomitant thyroid diseases.