亚急性甲状腺炎诊疗研究进展

发布时间：2018-03-15 21:21

本文选题：亚急性甲状腺炎　切入点：诊断　出处：《南昌大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:亚急性甲状腺炎(Subacute thyroiditis,SAT)由De Quervain于1940年首先描述,又称De Quervain甲状腺炎、巨细胞性甲状腺炎、肉芽肿性甲状腺炎,是一种可自行恢复的甲状腺非细菌感染性疾病,临床发病率约为4.9/10万,是甲状腺疾病中的常见病和多发病,也是甲状腺疼痛最常见原因,可能与病毒感染或遗传易感性有关,常见于20-50岁女性[1]。大多数SAT患者根据其典型的临床表现、实验室检查、131碘摄取率、影像学检查以及甲状腺细针穿刺细胞学检查可明确诊断。由于部分患者症状不典型,极易误诊,需与其他甲状腺疾病相鉴别。临床上治疗急性期SAT常首选糖皮质激素。但SAT的病程长,容易复发,而且激素治疗中往往缺少判断疗效的统一标准。故临床中发现按常规方法减量和停药常常会导致病情反复发作。目的:通过综述目前SAT诊断以及治疗方法方面的研究,为临床降低误诊率以及更有效的治疗SAT提供一些理论参考。方法:以“亚急性甲状腺炎、诊断、鉴别诊断、治疗”等关键词检索自1990-2016年收录于MEDLINE,PubMed,OVID,APS Journals,Engineering Village,ScienceDirectJournal,SpringerLink,Elsevier,中国知网数据库一CNKI、维普数据库、万方数字化期刊群-WanFang、中国生物医学文献数据库-CBM中的关于SAT诊疗进展的文献共122篇,去除重复后余90篇,初筛后余77篇文献,排除5篇亚急性甲状腺炎合并格雷夫斯病文献,排除8篇桥本甲状腺炎合并亚急性甲状腺炎文献,纳入分析研究的共64篇文献进行检索,找出SAT诊断以及治疗的相关研究。结果与结论:目前已有大量关于SAT诊断及治疗的文献,综合这些研究结果我们可以更加准确掌握其诊断以及鉴别诊断。虽然糖皮质激素是目前临床上治疗急性期SAT的首选药物,但糖皮质激素的初始剂量、减量依据、停药时机以及总疗程尚无统一标准。所以糖皮质激素治疗SAT的安全性、有效性以及减量、停药的合适时机的确定还需大样本的前瞻随机对照研究来证实。
[Abstract]:Background: subacute thyroiditis is first described by de Quervain in 1940. It is also called de Quervain thyroiditis, giant cell thyroiditis, granulomatous thyroiditis. The clinical incidence is about 4.9 / 100,000, which is a common and frequent disease in thyroid disease, and the most common cause of thyroid pain, which may be related to virus infection or genetic susceptibility. Women aged 20-50 years [1] .According to their typical clinical manifestations, most SAT patients can be clearly diagnosed by laboratory examination of iodine uptake rate, imaging examination, and fine needle aspiration cytology of thyroid gland. It is easy to be misdiagnosed and needs to be distinguished from other thyroid diseases. Glucocorticoid is the first choice in clinical treatment of acute SAT. However, the course of SAT is long and easy to recur. In addition, hormone therapy often lacks a unified standard to judge the curative effect. Therefore, it is found in clinical practice that reduction and withdrawal of drugs in accordance with conventional methods often lead to recurrent attacks of the disease. Objective: to review the current research on SAT diagnosis and treatment methods. To reduce the rate of misdiagnosis and to provide some theoretical reference for the more effective treatment of SAT. Methods: to "subacute thyroiditis, diagnosis, differential diagnosis," A total of 122 articles on the progress of SAT diagnosis and treatment were retrieved from 1990 to 2016 in MEDLINE OVID-OVID-APS Journals Engineering VillageScience Direct Journals, CNKI, Weip Database, Wanfang Digital Journal Group, Wan Fang. Chinese Biomedical Literature Database (-CBM), China National knowledge Network Database (CNKI), Weip Database, Wanfang Digital Journal Group, and Chinese Biomedical Literature Database (-CBM). After removing duplication, 90 articles, 77 articles after screening, 5 articles of subacute thyroiditis combined with Graves disease, 8 articles of Hashimoto thyroiditis with subacute thyroiditis were excluded. A total of 64 articles were searched to find out the diagnosis and treatment of SAT. Results and conclusions: there are a large number of literatures on diagnosis and treatment of SAT. Combined with these results, we can have a more accurate diagnosis and differential diagnosis. Although glucocorticoid is the first choice in clinical treatment of acute SAT, the initial dose of glucocorticoid is based on the reduction of glucocorticoid. There is no uniform standard for the timing of withdrawal and the total course of treatment. Therefore, the determination of the safety, efficacy and reduction of glucocorticoid in the treatment of SAT needs to be confirmed by a large sample of prospective randomized controlled studies.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581.4

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