【摘要】 目的探讨免疫学标记在甲状腺细针抽吸细胞学诊断中应用的价值。方法用免疫细胞化学方法观察938例甲状腺细针抽吸标本涂片中各种甲状腺疾病的细胞形态及HLA-DR、S-100和CD44蛋白表达。结果诊断或提示可能性诊断为良性病变(慢性淋巴细胞性甲状腺炎、结节性甲状腺肿、临床甲状腺功能亢进、甲状腺腺瘤、亚急性甲状腺炎)约占80%。不能诊断或不能提示可能性诊断的各种疾病(含陈旧性出血)约占16%。恶性肿瘤的诊断比例不足4%。提示可能性诊断为慢性淋巴细胞性甲状腺炎、临床甲状腺功能亢进涂片的甲状腺滤泡上皮胞浆中HLA-DR表达阳性率分别为47.9%和15.8%。而S-100蛋白在良、恶性病变中均有程度不同的表达。CD44棕黄色免疫阳性反应物见于提示可能性诊断为恶性病变中92%的异形细胞胞膜,未见于其他细胞中。结论HLA-DR抗原表达在弥漫性毒性甲状腺肿、桥本甲状腺炎有助于与其他有淋巴细胞浸润疾病的鉴别诊断,CD44阳性表达在高分化滤泡癌,在与腺瘤的鉴别诊断中有一定的参考价值。更多还原

【Abstract】 Objective To evaluate the significance of immune markers in cytologic diagnosis of thyroid diseases with fine needle aspiration (FNA). Methods A morphologic study and HLA DR, S 100 and CD44 expressions by cytochemical and immunocytochemical techniques were performed for cytologic diagnosis of thyroid diseases in 938 samples with FNA. Results The diagnosed and tentatively diagnosed benign diseases (including lymphocytic thyroiditis, nodular goiter, clinical hyperthyroidism, adenoma of thyroid, subacute thyroiditis) accounted for about 80%, undiagnosed cases about 16% and malignant diseases less than 4%. HLA DR was positive in 47.9% and 15.8% cases of tentatively diagnosed lymphocytic thyroiditis and clinical hyperthyroidism respectively. The S 100 expression was similar in various thyroid diseases. CD44 was positive in 92% of malignant cells, but not in other cells. Conclusion Positive HLA DR expression coutributes to the differentiating diagnosis of Graves′ disease and Hashimoto′s thyroiditis from other thyroid disease with lymphocytic infiltration. Positive CD44 expression has a certain significance in differentiating the well differentiated follicular carcinoma from benign adenoma of thyroid.更多还原