亚临床甲状腺功能异常临床细胞病理学分析

Clinical cytopathologic research on subclinical thyroid dysfunction.

目的探讨亚临床甲状腺功能减退症(亚临床甲减)和亚临床甲状腺功能亢进症(亚临床甲亢)的病因及临床特点。方法对1994年9月至2005年12月北京大学第一医院符合诊断标准的90例亚临床甲减和48例亚临床甲亢患者的细针穿刺细胞病理学检查(FNAC)结果进行分析,同时测定甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPOAb)。结果(1)根据细胞病理学诊断,亚临床甲减最多见于桥本甲状腺炎(81.71%),其次为甲状腺肿(12.19%),甲状腺腺瘤(3.66%)较少见;亚临床甲亢多见于桥本甲状腺炎(41.86%)、甲状腺肿(34.88%)、甲状腺腺瘤(13.95%)。(2)亚临床甲减TGAb和TPOAb阳性率明显高于亚临床甲亢(P<0.01);桥本甲状腺炎TGAb和TPOAb阳性率在亚临床甲减中分别为83.08%和84.62%,在亚临床甲亢中分别为77.78%和55.56%。(3)桥本甲状腺炎的病理类型、相同病因的细胞病理形态在亚临床甲减和亚临床甲亢中未见明显差异。结论桥本甲状腺炎是亚临床甲减的最常见病因,在亚临床甲亢的病因中也占有重要地位;亚临床甲减自身抗体阳性率明显高于亚临床甲亢;从细胞病理学上不能区分亚临床甲状腺疾病的功能状态。

Objective To investigate the etiopathogenisis and the clinical characteristics of subclinical hypothyroidism and subclinical hyperthyroidism by analyzing their thyroid fine needle aspiration cytologic （FNAC） results. Methods FNAC results during Septemper 1994 and December 2005 in Peking University First Hospital were reviewed in 90 patients with subclinical hypothyroidism and 48 ones with subclinical hyperthyroidism, and their serum levels of TGAb and TPOAb were measured. Results （ 1 ） The cytologic pathological results showed Hashimoto＇s thyroiditis was the most common in subclinical hypothyroidism（81.71% ） ,while goiter and thyroid adenoma were less to be seen （ 12. 19% and 3.66% respectively）. In subclinical hyperthyroidism, Hashimoto＇s thyroiditis （ 41.86% ）, goiter （ 34. 88% ） and thyroid adenoma （13. 95% ）were all seen frequently. （2）The positive rates of TGAb and TPOAb in the former was significantly higher than those in the latter （ P 〈0. 01 ）. In subchnical hypothyroidism,the positive rates of TGAb and TPOAb in Hashimoto＇s thyroiditis were 83.08% and 84. 62%, and those in subclinical hyperthyroidism were 77. 78% and 55.56% respectively. （ 3 ） The pathological type of Hashimoto＇s thyroiditis and the cytopathological morphous of the same pathogeny had no obvious difference bctwe,.n subclinical hypothyroidism and subclinical hyperthyroidism. Conclusion Hashimoto＇s thyroiditis is the most common cause of subclinical hypothyroidism and plays an important role in the etiopathogenisis of subclinical hyperthyroidism. The positive rates of TGAb and TPOAb in subclinical hypothyroidism are significantly higher than those in subclinical hyperthyroidism. The different functions of subclinical thyroid disease can not be distinguished only by their cytologic pathology.