【作者】 赵海平；

【导师】 江昌新；

【作者基本信息】 天津医科大学 ， 病理学与病理生理学， 2003， 硕士

【摘要】 结节性甲状腺肿(结甲肿)和甲状腺腺瘤是较常见的甲状腺疾病。其发生发展与患者的年龄、性别、碘摄入量、生活环境、遗传等因素密切相关。本研究第一部分收集天津医科大学总医院病理科1978～2002年的结甲肿和甲状腺腺瘤的病理及临床资料，应用游程检验、升降趋势检验、方差分析、t或t’检验、x~2检验等统计学方法，观察天津市实施预防性碘盐供给前后，结甲肿、甲状腺腺瘤的外检率、构成比、平均确诊年龄、性别比例、“伴发病变”的变化。为进一步探讨结甲肿、甲状腺腺瘤的发病因素、碘与两病的关系和临床诊治该病提供病理统计学依据。 甲状腺细针抽吸细胞学检查因其简便、经济、安全、有效、并发症少，已成为筛查甲状腺结节性疾病，区别良恶性的参考方法之一。结合临床资料可对绝大多数甲状腺疾病作出诊断。本研究第二部分对黄河医院1998～2002年和天津医科大学总医院1996～2002年甲状腺细针抽吸细胞涂片进行病理形态学观察；应用方差分析、t或t’检验、及x~2检验等统计学方法，对甲状腺细针抽吸细胞诊断的各疾病的构成比、平均年龄、性别比例进行分析，并与总医院25年手术病理切片诊断结甲肿、甲状腺腺瘤的统计结果进行比较。以探讨甲状腺细针抽吸细胞检查在临床诊断中的应用和各甲状腺疾病的发病情况。 结果发现： 1、1978～2002年25年间天津医科大学总医院病理科外检标本总数为211765例(平均8471例／年)，甲状腺标本共5512例(平均220例/年)，总平均外检率2.60%，82年以后呈下降趋势，95年后呈明显上升趋势。其中结甲肿2820例(平均113例/年)，总平均外检率1.33%，总平均构成比51.16%，呈上升趋势;甲状腺腺瘤1264例(平均51例/年)，总平均外检率0.60%，总平均构成比22.93%，呈下降趋势。25年中两病及其女性平均确诊年龄均呈上升趋势，且结甲肿平均确诊年龄高于甲状腺腺瘤，两病中男性平均确诊年龄亦均高于女性。伴有腺瘤样增生和乳头状增生结甲肿的男性平均确诊年龄高于女性;伴有微小癌和临床甲亢症状结甲肿的男性平均确诊年龄低于女性。25年中结甲肿与甲状腺腺瘤的性别比例无明显差别(男:女均为1:3一4)。临床有甲亢症状的结甲肿中以乳头状增生和微小癌两种“伴发病变”的构成比最高。 2、各种甲状腺疾病的细针抽吸细胞学病理形态学特征各异。黄河医院1998一2002年甲状腺细针抽吸细胞总例数676例(平均135例/年)。总医院1996一2002年甲状腺细针抽吸细胞总例数222例 (平均32例/年)。两所医院的慢性淋巴细胞性甲状腺炎均为甲状腺细针抽吸诊断的首位病变。结甲肿、腺瘤术后病理切片的构成比均高于涂片诊断病例的构成比。甲状腺细针抽吸诊断临床甲亢的平均年龄小于慢性淋巴细胞性甲状腺炎;结甲肿和甲状腺腺瘤的平均年龄差异无显著性;恶性肿瘤的平均年龄最大。涂片诊断甲状腺腺瘤及其中男性、女性的平均年龄均高于切片诊断病例;两所医院合并涂片诊断结甲肿的总平均年龄及其中男性、女性的平均年龄和切片诊断病例差异无显著性。两所医院甲状腺细针抽吸细胞诊断的各疾病的女性病例均多于男性，男女比例在1:3.00一1:18.50之间。涂片诊断的结甲肿、腺瘤女性与男性比例均高于切片诊断病例。各甲状腺疾病每年平均年龄、性别比例均未见明显变化趋势。 结论: 1、25年甲状腺疾病、结甲肿、甲状腺腺瘤发病的阶段性趋势变化与碘摄入量变化密切相关。结甲肿的发病率在甲状腺疾病中居首位。两病女性发病早于男性。结甲肿、甲状腺腺瘤均女性病例多于男性，男性与女性的比例均为1:3一4。伴有乳头状增生和微小癌的结甲肿出现临床甲亢症状多于腺瘤样增生。 2、甲状腺细针抽吸诊断的首位病变是慢性淋巴细胞性甲状腺炎。结甲肿较甲状腺腺瘤常见，两者之比为1:2一5。临床甲亢平均年龄小于慢性淋巴细胞性甲状腺炎。各甲状腺疾病均多见于女性，尤其慢性淋巴细胞性甲状腺炎，其女性患者远多于男性，男女比例将近l:20。更多还原

【Abstract】 The occurrence and progression of nodular goiter and thyroid adenoma, two of common thyroid diseases, have close relations with age, sex, iodine intake, living environment, inheritance and so on. The first part of present study was designed to statistically analyze the clinico-pathologic data of patients with nodular goiter and thyroid adenoma taken from files of Department of Pathology (1978-2002) in General Hospital, Tianjin Medical University, with Run test, Cox梥tuart test, ANOVA, t or t’ test and Chi梥quare test. We observed the changes in biopsy ratios, proportions, mean ages, sex rates and coexisting lesions of nodular goiter and thyroid adenoma before and after iodine prophylaxis and offered statistical data of pathology for further exploration of their pathogenesis and the relationship between iodine and the two diseases and clinical diagnosis and therapy of these diseases.Because of its simple, economy, safety, validity, little complications, fine-needle aspirates biopsy (FNA) of the thyroid has been regarded as one referenced method of preoperative evaluation of thyroid lesions, distinction malignant. Combined with clinical features, it may provide correct diagnosis for most thyroid diseases. In the second part of present study, we observed the cytopathologic characteristics of FNA performed in the years of 1996-2002 in Department of Pathology in General Hospital, Tianjin Medical University, and in the years of 1998-2002 in Department of Pathology in Huanghe Hospital. We analysed the proportions, mean ages, sex rates of the thyroid diseases diagnosed by FNA with ANOVA, t or t’ test and Chi-square test, and compared the results of the two partsof present study. This part of study is designed to explore the application of FNA in clinical diagnosis and the incidence of thyroid diseases.Results were as following:1. The biopsy numbers of total thyroid diseases, nodular goiter, thyroid adenoma in the twenty梖ive years were 551% 2820, 1264 respectively. The average biopsy ratios of total thyroid diseases, nodular goiter and thyroid adenoma were 2. 60%, 1. 33%, 0. 60% respectively. Biopsy ratio of thyroid diseases in total showed a descending tendency from 1982 and an ascending tendency from 1995. Biopsy ratio and proportion of nodular goiter showed an ascending tendency while thyroid adenoma showed a descending tendency during the twenty-five years. Mean age of total and female patients with the two diseases showed an ascending tendency during the twenty梖ive years. Mean age of nodular goiter was higher than thyroid adenoma. Mean age of male patients with the two diseases was higher than female patients. Adenomatous hyperplasia and papillary hyperplasia were seen earlier in female patients with nodular goiter, occult carcinoma and hyperthyroidism were seen earlier in male patients with goiter nodular. Difference was not significant in sex rate between nodular goiter and thyroid adenoma (both were 1:3-4) in the twenty-five years. Rise was found in proportion of hyperthyroidism in nodular goiter coexisting papillary hyperplasia or occult carcinoma.2. The FNA cytopathologic characteristics of thyroid diseases were various. The total number of thyroid FNA in Huanghe Hospital was 676(average 135/ year). The total number of thyroid FNA in the GeneralHospital was 222 (average 32/year). Chronic lymphocytic thyroiditis was the most common diagnosis of thyroid FNA. The proportions of nodular goiter and thyroid adenoma in thyroid operations were higher than those in FNAs. The average age of clinical hyperthyroidism was lower than Chronic lymphocytic thyroiditis. Nodular goiter and thyroid adenoma diagnosed by FNA had no significant difference in average ages. The highest average age was in patients with malignant tumor. The average age of thyroid adenoma performed FNA were higher than those performed operations. The average age of nodular goiter performed FNA in the two hospital was not different from those performed operations. Female patients with thyroid diseases were more than male patients.更多还原