甲状腺嗜酸细胞腺瘤与结节性甲状腺肿的临床特点比较

Comparison of clinical characteristics of Hürthle cell adenoma and multinodular goiter

目的:比较甲状腺嗜酸细胞腺瘤(Hürthle cell adenoma,HCA)与结节性甲状腺肿(multinodular goiter,MNG)患者的临床特点,为诊断HCA提供临床线索。方法:收集2000年1月至2017年12月因甲状腺结节在北京大学第一医院就诊行手术切除,并经术后石蜡病理确诊的HCA患者92例,同时选取年龄、性别、手术年份匹配的MNG患者276例按1∶3进行配对,分析比较2组患者病程、临床表现、甲状腺功能状态、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)、甲状腺球蛋白(thyroglobulin,Tg)、超声等差异。结果:2组患者家族史、病程、临床表现、术前甲状腺功能状态、TPOAb、TgAb、Tg阳性率均无明显差异;HCA组患者甲状腺结节的最大径值明显大于MNG组(P<0.05),其中HCA组中≥2 cm结节的比例明显大于MNG组(P<0.05);HCA组单发、实性结节、超声中结节内血流丰富患者的比例明显多于MNG组(P<0.05)。结论:HCA及MNG患者仅从病程、症状、甲状腺功能、抗体方面难以区分。较大、单发、实性结节、超声结节内血流丰富提示HCA可能。

Objective:To compare the clinical characteristics of patients with Hürthle cell adenoma (HCA) and multinodular goiter (MNG),and to summarize the clues for the diagnosis of HCA. Methods:A total of 92 patients,who underwent resection of thyroid nodules in Peking University First Hospital from January 2000 to December 2017 and were confirmed to have HCA according to postoperative histopathological analysis of paraffin-embedded sections,were enrolled. Meanwhile,276 age-,sex-,and year-of-operation-matched patients with MNG were enrolled and paired with the above patients with HCA at a ratio of 3∶1. The two groups of patients were compared for the differences in course of disease,clinical manifestations,thyroid function,thyroid peroxydase antibody (TPOAb),thyroglobulin antibody(TgAb),thyroglobulin(Tg),and ultrasonographic characteristics. Results:There were no significant differences between the two groups in patients’family history,course of disease,clinical manifestations,preoperative thyroid function, and positive rates of TPOAb,TgAb,and Tg. The maximum diameter of thyroid nodules in the HCA group was significantly larger than that in the MNG group(P<0.05),and the rate of nodules with a diameter of not less than 2 cm was significantly higher in the HCA group than in the MNG group(P<0.05). The HCA group had a significantly higher proportion of patients with solitary and solid nodules and abundant intra-nodular blood flow on ultrasonography than the MNG group(P <0.05). Conclusion:It is difficult to distinguish HCA from MNG just from the course of disease,symptoms,thyroid function,and presence or absence of antibodies. It may indicate the possibility of HCA if relatively large,solitary,and solid nodules with abundant intra-nodular blood flow are found on ultrasonography.