自身免疫性甲状腺疾病细胞学变化与自身抗体及临床转归的关系

RELATIONSHIP BETWEEN CYTOLOGIC CHANGES OF AUTOIMMUNE THYROID DISEASE AND AUTO-ANTIBODY AS WELL AS DISEASE PROGNOSIS

采用ＦＮＡＢ方法检查１１５例自身免疫性甲状腺疾病（ＡＩＴＤ）患者，治疗前分别按甲状腺内淋巴细胞浸润程度和腺上皮细胞变异程度进行分组，观察血清自身抗体ＴＭＡ、ＴＧＡ水平与ＴＲＡｂ、ＴＳＡｂ阳性率，及其与细胞学异常变化的关系，并随访停药后甲状腺细胞学情况，观察其与疾病复发的关系。结果表明，血清ＴＭＡ、ＴＧＡ与淋巴细胞浸润程度关系密切，ＴＲＡｂ、ＴＳＡｂ阳性率与腺上皮细胞变异程度有明显相关性。并且，停药后细胞学异常组复发率１００％，显著高于非异常组。复发组细胞学异常程度和比例与未复发组比较差异显著（Ｐ＜０．０１）。提示停药时甲状腺内淋巴细胞浸润和腺上皮细胞变异程度，可能是疾病容易复发的标志之一。

FNAB method was adopted to examine 115 cases of autoimmune thyroid disease(AITD) patients, who were divided into groupsaccording to degree of lymphocytic infiLtration in the thyroid and the degree of epithelioglandular variation. The relationship be-tween levels of serum auto-antibodies, TMA and TGA, and positive rates of TRAb and TSAb,and cytologic changes of thyroidboth before and after treatment as well as one year following withdrawal of the drug was studied. The results showed that the levelsof serum TMA and TGA presented a positive correlation with the degree of lymphocytic infiltration in thyroids (P<0. 05);whilethe positive rates of TRAb and TSAb had no apparent relation with the degree of lymphocytic infiltration, but had a close relation-ship with the degree of epitheliogladular variation(P<0.05).After withdrawal of medicine,the recurrence rate of cytologically ab-normal group(100%)was significantly highcr than the cytologically normal group.The degree and percentage of cytological abnor-malities were significantly higher in the recurrent group than in the non-recurrent group(P<0. 01)。Thus,thyroid cytologic abnor-malities and epithelioglandular variation may be used as indications for disease recurrence after medicine discontinuation.