儿童慢性淋巴细胞性甲状腺炎的诊断探讨

为探讨儿童弥漫性甲状腺肿的简便和精确的诊断方法，对已经细针穿刺细胞学检查和甲状腺自身抗体检测的５０例弥漫性甲状腺肿患儿同时应用Ｂ超进行了甲状腺扫描检查，以１０９名７～１４岁正常儿童的甲状腺超声影像作对比。结果：正常儿童甲状腺的影像为略强于其周围肌肉组织的均匀回声图；弥漫性甲状腺肿患儿的甲状腺体积明显大于正常同龄儿童；细胞学确诊为慢性淋巴细胞性甲状腺炎的２６例中２２例（８４．６％）Ｂ超回声图像呈大小不等的低回声区改变，其中１８例（８１．８％）伴自身抗体阳性；而细胞学诊断为甲状腺弥漫性增生的２４例患儿中则１７例（７０．８％）Ｂ超回声图像正常，仅７例（２９．１％）呈异常回声图，且均伴自身抗体阳性，其中２例１年后细胞学复查证实为慢性淋巴细胞性甲状腺炎。Ｂ超结合自身抗体的检测与细胞学检查的诊断符合率为９２％。提示：Ｂ超作为一种简便易行、无创伤、可反复进行的检查手段，辅以血清学检测，对儿童慢性淋巴细胞性甲状腺炎的诊断有较好的实用价值。

Investigation on diagnostic procedure for chronic lymphocytic thryoiditis in children

To find an easy and accurate procedure for the diagnosis of diffuse thyroid disorder in children, the authors examined 50 patients with diffuse goitre with fine needle aspiration biopsy cytology, thyroid antibody detection, thyroid hormone analysis and ultrasound imaging. In the meantime, 109 normal children (control) were examined by ultrasound imaging. The results showed that thyroid imaging in healthy children was a smooth echo pattern with stronger homogenous echogram than surrounding muscle tissue. The patients with diffuse goiter showed an abnormally enlarged thyroid volume. Ultrasonic imaging showed a variedly patchy hypoechogenicity in 22 (84.6%) of 26 children with chronic lymphocytic thyroiditis, of whom 18 (81.8%) had positive results of antibody testing. Contrarily, echo patterns were normal in 17 (70.8%) of 24 patients with diffuse thyroid proliferation and only the remainders (7/24,29.1%) had abnormal echo patterns as well as elevated autoantibody titers, of whom 2 were confirmed as chronic lymphocytic thyroiditis by repeated fine needle aspiration biopsy 1 year later. With combined ultrsound imaging and antibody determination, 92% of the cases of chronic lymphocytic thyroiditis could be diagnosed. Thus, our study suggests that ultrasonic imaging be an easy, noninvasive, reproducible and a valuable procedure in the differential diagnosis of chronic lymphocytic thyroiditis in children when combined with serological tests.