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目的探讨Ig G4在桥本甲状腺炎中的表达及其相关的临床病理特征,为Ig G4 HT的诊断、鉴别诊断与治疗提供依据。方法通过对桥本甲状腺炎、亚急性甲状腺炎、结节性甲状腺肿等疾病的甲状腺组织进行HE和免疫组化染色,结合B超、临床资料等分析Ig G4 HT的临床病理特征。结果 41例HT中,CD3、CD20、CD38、CD138、Ig G均为阳性,Ig G4 HT有13例(31.71%),其中Ig G、Ig G4阳性明显高于非Ig G4 HT组,差异具有统计学意义(P<0.05);结合临床、B超检查及HE染色显示Ig G4 HT的平均发病年龄为(49.2±9.32)岁,常表现为弥散低回声或混合回声结节,且间质纤维化程度更加明显,差异均具有统计学意义(P<0.05)。结论 HT存在免疫功能异常,其中Ig G4 HT亚型并不少见,自身抗原的持续暴露可以使Ig G4滴度升高并诱导纤维化的发生,这类患者具有特殊的临床病理特征,组织病理学及Ig G4免疫组织化学检查有助于Ig G4 HT患者的及时诊断和治疗。
Objective To investigate the expression of Ig G4 in Hashimoto’s thyroiditis and its clinical and pathological features, and to provide evidence for the diagnosis, differential diagnosis and treatment of Ig G4 HT. Methods The histopathological features of Ig G4 HT were analyzed by HE and immunohistochemical staining of thyroid gland in Hashimoto’s thyroiditis, subacute thyroiditis and nodular goiter. Combined with B-ultrasonography and clinical data, the clinical and pathological features of Ig G4 HT were analyzed. Results Thirty-one cases of HT were positive for CD3, CD20, CD38, CD138 and Ig G, and 13 cases (31.71%) were positive for Ig G4 HT. The positive rates of Ig G and Ig G4 in HT were significantly higher than those in non-Ig G4 HT (P <0.05). Combined with clinical, B-ultrasonography and HE staining showed that the mean age at onset of Ig G4 HT was (49.2 ± 9.32) years old, with diffuse hypoechoic or mixed echogenic nodules and interstitial fibrosis The degree of more obvious differences were statistically significant (P <0.05). Conclusions There are immunological abnormalities in HT. Among them, Ig G4 HT subtype is not uncommon. Continuous exposure of autoantigen can increase Ig G4 titer and induce fibrosis. These patients have special clinicopathological features, histopathology And Ig G4 immunohistochemistry are helpful for the timely diagnosis and treatment of Ig G4 HT patients.