桥本氏甲状腺炎一、疾病定义与概述二、临床诊断三、治疗措施四、中医认识五、最新进展内容提要Hashimoto’sdisease:Aprogressivediseaseofthethyroidglandcharacterizedbythepresenceofantibodiesdirectedagainstthethyroidandbyinfiltrationofthethyroidglandbylymphocytes(whitebloodcellsactivatedbytheimmunesystem).HashimotodiseaseisthemostcommoncauseofhypothyroidisminNorthAmericaandEurope.InHashimotodisease,thethyroidglandisusuallyenlarged(goiter)andhasadecreasedabilitytomakethyroidhormones.Hashimotodiseasepredominantlyaffectswomen,anditcanbeinherited.AlsoknownasautoimmunethyroiditisandHashimotothyroiditis.Definition：http://www.medterms.com/script/main/art.asp?articlekey=21007桥本氏甲状腺炎概述：自身免疫性甲状腺炎之一日本学者Hashimoto于1912年首先报道相关名称：桥本甲状腺炎Hashimoto'sthyroiditis，HT桥本氏病Hashimoto'sdisease,HD慢性淋巴细胞性甲状腺炎ChroniclymphocyticthyroiditisDr.HakaruHashimoto甲状腺炎概述：指甲状腺组织发生变性、渗出、坏死、增生等炎性病理改变而导致的一系列临床病症桥本甲状腺炎Hashimotothyroiditis萎缩性甲状腺炎atrophicthyroiditis无痛性甲状腺炎painlessthyroiditis产后甲状腺炎postpartumthyroiditis自身免疫性甲状腺炎autoimmunethyroiditisAITD自身免疫性甲状腺炎：桥本甲状腺炎Hashimotothyroiditis萎缩性甲状腺炎atrophicthyroiditis慢性淋巴细胞性甲状腺炎chroniclymphocyticthyroiditis无痛性甲状腺炎painlessthyroiditis产后甲状腺炎postpartumthyroiditis自身免疫性甲状腺炎autoimmunethyroiditisAITD自身免疫性甲状腺炎：流行病学：占甲状腺疾病的20-25%饮食富碘地区引发甲状腺肿性甲状腺功能减退的最常见原因引发儿童非地方性甲状腺肿的最主要病因多发于30-50岁中年女性，发病率，男：女为1:10流行率：0.4-1.5%（中国）发病率：0.15%（美国）0-0.5%（中国）近30年来发病率持续增高TengW,ShanZ,TengX,etal.EffectofiodineintakeonthyroiddiseasesinChina.NEnglJMed.2006,354(26):2783-93.病因与发病机制：遗传因素：目前肯定的遗传易感基因包括人类白细胞抗原（HLA)和细胞毒性T淋巴细胞相关抗原-4(CTLA-4)环境因素：高碘、硒缺乏、感染、应用胺碘酮、IFN-α治疗,锂盐,吸烟等自身免疫因素TgAb,TPO-Ab,TSB-Ab,Fas，ADCC（抗体依赖性细胞介导的细胞毒作用）TSH-RTRAbTSHTSAbTSBAbTGIHCGT3,T4TSH受体配体TSBAb桥本甲状腺炎TSH受体与甲状腺功能：病理作用生理效应NormalthyroidglandTSB-AbEnd-stageHashimotothyroiditis*-->Hypothyroidism*initially:goiterinflammationTSAbGravesdiseasevvvHyperthyroidismNormalthyroidglandTSHAutoimmuneThyroidDisease（AITD）TPOTPO-Ab+细胞毒作用NK细胞ADCCTPO-Ab损伤甲状腺滤泡[肉眼]甲状腺弥漫性对称性肿大，稍呈结节状，质较韧，60g～200g左右，被膜轻度增厚，与周围组织无粘连，切面呈分叶状，色灰白灰黄。[光镜]实质组织破坏、萎缩，大量淋巴细胞及不等量的嗜酸性粒细胞浸润、淋巴滤泡形成、纤维组织增生，有时可出现多核巨细。病理特征：典型活检病理特征：ThespecimeninPanelAshowsThespecimeninPanelAshowstypicalchangesofHashimoto'stypicalchangesofHashimoto'sthyroiditis,includinglymphoidthyroiditis,includinglymphoidfollicleswithgerminalcenters(G),follicleswithgerminalcenters(G),smalllymphocytesandplasmasmalllymphocytesandplasmacells(P),thyroidfollicleswithcells(P),thyroidfollicleswithHürthle-cellmetaplasia(H),andHürthle-cellmetaplasia(H),andminimalcolloidmaterial(C).minimalcolloidmaterial(C).G:淋巴滤泡生发中心P:小淋巴细胞和浆细胞H:甲状腺滤泡与何氏细胞化生C:胶体物质PearceEN,FarwellAP,BravermanLE.Thyroiditis.NEnglJMed2003;348:2646-2655.典型桥本氏甲状腺炎病变组织样本(A)Diagnose甲减伴甲状腺萎缩甲亢表现甲状腺肿大甲减表现和或和或甲状腺功能TPoAb，TgA...
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