核医学检查在甲状腺炎诊断中的临床意义
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摘要
目的探讨核医学检查项目(摄碘率、甲状腺显像、血清学检测)在甲状腺炎诊断中的临床意义。方法回顾性调查在东风医院住院的44例亚急性甲状腺炎(SAT)、41例桥本甲状腺炎(HT)和40例甲状腺功能亢进症(GD)患者的摄碘率、甲状腺显像和血清学检测水平,与40例健康检查者进行对比分析。结果摄碘率:3组甲状腺疾病患者3和24 h摄碘率与对照组比较,差异有统计学意义(P<0.01),GD组摄碘率高于对照组,SAT与HT组摄碘率均低于对照组,SAT组摄碘率低于HT组。甲状腺显像:SAT组患者甲状腺轮廓显示不清晰,甚至未见甲状腺显影;HT组患者甲状腺显影,放射性分布不均匀;GD组患者甲状腺轮廓清晰,摄锝功能增高。血清学检测:3组甲状腺疾病患者血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)值均升高,与对照组比较,差异有统计学意义(P<0.01),SAT组FT3、FT4水平较GD组低,但较HT组高。甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)水平在3组甲状腺疾病患者中均升高,与对照组比较,差异有统计学意义(P<0.01或P<0.05)。结论摄碘率测定联合甲状腺显像能准确反映甲状腺病变受累的范围、程度及功能状态,在甲状腺炎诊断中起重要作用,且辅助血清学检测及临床表现有助于鉴别SAT与HT患者。
[Objective]To explore the clinical significance of nuclear medicine examinations(radioactive iodine uptake,thyroid imaging and serological detection) in the diagnosis of thyroiditis. [Methods]A retrospective investigation was conduct to analyze the results of radioactive iodine uptake,thyroid imaging and serological detection in 44 cases of subacute thyroiditis(SAT),41 cases of Hashimoto sthyroiditis(HT)and 40 cases of graves disease(GD),and the results were compared with the results of40 healthy controls.[Results]The radioactive iodine uptake:there were significant differences in 3-hour and 24-hour iodine uptake rate between three disease groups and the control group(P<0.01),the iodine uptake rate in GD group was higher than that in the control group,the iodine uptake rates in SAT group and HT group were lower than that in the control group,and the iodine uptake rate in SAT group was lower than that in HT group. The thyroid imaging:the thyroid image of SAT group is not clear,or the thyroid image is not observed. The thyroid image of HT group can be observed,but the distribution of radioactivity is uneven.The thyroid image of GD group can be clearly observed,and 99 m Tc-pertechnetate uptake increases. The serological detection:the levels of FT3 and FT4in three disease groups were higher than those in the control group,and the differences were statistically significant(P<0.01). The levels of FT3 and FT4 in SAT group were lower than those in GD group,but were higher than those in HT group. The levels of TGAb and TPOAb in three disease groups were higher than those in the control group,and the differences were statistically significant(P<0.01 or P<0.05).[Conclusion]Radioactive iodine uptake combined with thyroid imaging can accurately reflect the thyroid lesions range,degree and function state,which play an irreplaceable role in the diagnosis of thyroiditis. Combined with serological examination and the clinical manifestations,the method is helpful to identify SAT or HT patients.
[Objective]To explore the clinical significance of nuclear medicine examinations(radioactive iodine uptake,thyroid imaging and serological detection) in the diagnosis of thyroiditis. [Methods]A retrospective investigation was conduct to analyze the results of radioactive iodine uptake,thyroid imaging and serological detection in 44 cases of subacute thyroiditis(SAT),41 cases of Hashimoto sthyroiditis(HT)and 40 cases of graves disease(GD),and the results were compared with the results of40 healthy controls.[Results]The radioactive iodine uptake:there were significant differences in 3-hour and 24-hour iodine uptake rate between three disease groups and the control group(P<0.01),the iodine uptake rate in GD group was higher than that in the control group,the iodine uptake rates in SAT group and HT group were lower than that in the control group,and the iodine uptake rate in SAT group was lower than that in HT group. The thyroid imaging:the thyroid image of SAT group is not clear,or the thyroid image is not observed. The thyroid image of HT group can be observed,but the distribution of radioactivity is uneven.The thyroid image of GD group can be clearly observed,and 99 m Tc-pertechnetate uptake increases. The serological detection:the levels of FT3 and FT4in three disease groups were higher than those in the control group,and the differences were statistically significant(P<0.01). The levels of FT3 and FT4 in SAT group were lower than those in GD group,but were higher than those in HT group. The levels of TGAb and TPOAb in three disease groups were higher than those in the control group,and the differences were statistically significant(P<0.01 or P<0.05).[Conclusion]Radioactive iodine uptake combined with thyroid imaging can accurately reflect the thyroid lesions range,degree and function state,which play an irreplaceable role in the diagnosis of thyroiditis. Combined with serological examination and the clinical manifestations,the method is helpful to identify SAT or HT patients.
引文
[1]杨晓南,张效志,尔启东.甲状腺结节187例手术治疗分析[J].海南医学,2010,21(5):71-72.
[2]Song YS,Jang SJ,Chung JK,et al.F-18 fluorodeoxyglucose(FDG)positron emission tomography(PET)and Tc-99m pertechnate scan findings of a patient with unilateral subacute thyroiditis[J].Clin Nucl Med,2009,34:456-458.
[3]叶廷军,袁勤,施新明,等.亚急性甲状腺炎患者的血清指标变化与细胞病理学特征[J].诊断学理论与实践,2009,8(4):401-404.
[4]陆永经.核医学与超声检查对亚急性甲状腺炎的诊断价值[J].中国医药导报,2013,10(8):162-166.
[5]丁正强,袁超,殷锴,等.甲状腺摄碘率测定在亚急性甲状腺炎和甲状腺功能亢进症诊断与鉴别诊断[J].安徽医学,2012,33(7):853-855.
[6]Tomer Y,Huber A.The etiology of autoimmune thyroid disease:a story of genes and environment[J].J Autoimmun,2009,32:231-239.
[7]张晓辉,彭祖光,李永明,等.99m Tc O4-动静态显像对桥本氏甲状腺炎临床诊断价值[J].中国实用医药,2012,7(12):22-24.
[8]厉淑红,胡成进.血清TGAb、TPOAb检测在甲状腺疾病中的诊断意义[J].中国实验诊断学,2011,15(2):347-348.
[9]邓小虎,周海中,朱亚林,等.甲状腺显像和功能测定在亚急性甲状腺炎与Graves'病诊断和鉴别诊断中的应用价值[J].放射免疫学杂志,2010,23(2):221-223.
[10]梁华举,马玉琴.桥本病与Graves病发病机制的研究进展[J].山东医药,2008,48(22):113-114.
[11]Chung YJ,Park KY,Ahn J,et al.Steroid-responsive recurrent encephalopathy associated with subacute thyroiditis[J].J Clin Neurol,2008,4:167-170.
[12]杨杨,刘铁峰,韩波.血清TGAb和TPOAb在桥本甲状腺炎诊断中的意义[J].临床和实验医学杂志,2010,9(17):1311-1312.
[13]朱月秀.桥本甲状腺炎甲状腺功能测定的临床分析[J].检验医学与临床,2010,7(23):2650-2651.
[14]章结楼,黄海泉,吕雪峰.亚急性甲状腺炎13例误诊原因分析[J].安徽医学,2010,31(4):377-378.
[2]Song YS,Jang SJ,Chung JK,et al.F-18 fluorodeoxyglucose(FDG)positron emission tomography(PET)and Tc-99m pertechnate scan findings of a patient with unilateral subacute thyroiditis[J].Clin Nucl Med,2009,34:456-458.
[3]叶廷军,袁勤,施新明,等.亚急性甲状腺炎患者的血清指标变化与细胞病理学特征[J].诊断学理论与实践,2009,8(4):401-404.
[4]陆永经.核医学与超声检查对亚急性甲状腺炎的诊断价值[J].中国医药导报,2013,10(8):162-166.
[5]丁正强,袁超,殷锴,等.甲状腺摄碘率测定在亚急性甲状腺炎和甲状腺功能亢进症诊断与鉴别诊断[J].安徽医学,2012,33(7):853-855.
[6]Tomer Y,Huber A.The etiology of autoimmune thyroid disease:a story of genes and environment[J].J Autoimmun,2009,32:231-239.
[7]张晓辉,彭祖光,李永明,等.99m Tc O4-动静态显像对桥本氏甲状腺炎临床诊断价值[J].中国实用医药,2012,7(12):22-24.
[8]厉淑红,胡成进.血清TGAb、TPOAb检测在甲状腺疾病中的诊断意义[J].中国实验诊断学,2011,15(2):347-348.
[9]邓小虎,周海中,朱亚林,等.甲状腺显像和功能测定在亚急性甲状腺炎与Graves'病诊断和鉴别诊断中的应用价值[J].放射免疫学杂志,2010,23(2):221-223.
[10]梁华举,马玉琴.桥本病与Graves病发病机制的研究进展[J].山东医药,2008,48(22):113-114.
[11]Chung YJ,Park KY,Ahn J,et al.Steroid-responsive recurrent encephalopathy associated with subacute thyroiditis[J].J Clin Neurol,2008,4:167-170.
[12]杨杨,刘铁峰,韩波.血清TGAb和TPOAb在桥本甲状腺炎诊断中的意义[J].临床和实验医学杂志,2010,9(17):1311-1312.
[13]朱月秀.桥本甲状腺炎甲状腺功能测定的临床分析[J].检验医学与临床,2010,7(23):2650-2651.
[14]章结楼,黄海泉,吕雪峰.亚急性甲状腺炎13例误诊原因分析[J].安徽医学,2010,31(4):377-378.