促甲状腺激素受体抗体在Graves病中的诊断价值  

Significance of thyrotrophic receptor antibody(TRAb) in clinical diagnosis of Graves' disease

作　　者：伍宁玲[1] 吕朝晖[1] 杜锦[1] 杨国庆[1] 巴建明[1] 窦京涛[1] 母义明[1] 陆菊明[1] 

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《解放军医学杂志》2011年第5期501-504,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析不同甲状腺疾病中促甲状腺激素受体抗体（TRAb）的水平及阳性率,探讨TRAb在Graves病中的诊断价值。方法采用酶联免疫分析法（ELISA）检测718例临床诊断的不同甲状腺疾病（298例初诊Graves病、212例原发性甲减、47例甲亢期亚急性甲状腺炎、161例甲状腺结节）患者和73例健康对照者的血清TRAb水平,并计算其阳性率。以Graves病患者和甲亢期亚急性甲状腺炎患者的TRAb作为数据源,采用SPSS 13.0绘制ROC曲线。结果不同甲状腺疾病患者中初诊Graves病患者血清TRAb水平（中位数22.45U/L）明显升高,其余甲状腺疾病组与健康对照组（中位数均为0.3U/L）差异无统计学意义。不同甲状腺疾病患者的血清TRAb阳性率之间差异有统计学意义,其中初诊Graves病患者阳性率最高（93.3%）,亚急性甲状腺炎和原发性甲减组（分别为14.9%、11.3%）次之,甲状腺结节组（1.2%）最低,且与健康对照组（1.4%）差异无统计学意义。初诊Graves病患者血清TRAb在各种滴度水平均有分布,其中38.3%的患者明显增高（〉30U/L）。亚急性甲状腺炎及原发性甲减也有少数患者血清TRAb明显增高（2.1%和0.5%）。ROC曲线分析显示血清TRAb用于Graves病的诊断有显著意义。Graves病与亚急性甲状腺炎的诊断切点为1.495U/L（敏感性93.9%,特异性85.1%）。在初诊的Graves病患者中,血清TRAb滴度水平与血清过氧化物酶抗体（TPO-Ab）呈正相关（P〈0.01）,与甲状腺球蛋白抗体（Tg-Ab）无明显相关。结论 ELISA法检测的TRAb主要为刺激性抗体,可用于Graves病和甲亢期亚急性甲状腺炎的鉴别诊断,但其滴度水平处于1.1113.65U/L时两种疾病重叠较多。Objective To investigate the clinical significance of serum thyrotrophic receptor antibody（TRAb） in the diagnosis of Graves’ disease（GD）.Methods Serum level of TRAb was measured with enzyme-linked immunosorbent assay（ELISA） in 298 untreated patients with GD,212 cases with hypothyroidism,47 cases with subacute thyroiditis,161 cases with thyroid nodule and 73 health controls.ROC curve with SPSS 13.0 was drawn according to the data from patients with GD and subacute thyroiditis.Results The mean value of serum TRAb was significantly higher in Graves’ patients than in patients with other thyroid diseases.The positive rates of TRAb was highest in GD patients（93.3%）,followed by the patients with subacute thyroiditis and hypothyroidism（14.9% and 11.3%）,and the lowest in the patients with thyoid nodule（1.2%）.Serum levels of TRAb in untreated GD showed various titers,and TRAb〉30U/L was more commonly found（38.3%）.ROC analysis showed that diagnostic code on TRAb for subacute thyroiditis and GD patients was 1.495U/L（93.5% sensitivity and 85.1% specificity）,and the doubtable value interval of 1.11U/L to 13.65U/L was determined.Finally,there was a positive correlation between the serum titer of TRAb and TPOAb（P〈0.01）.Conclusion TRAb measured by ELISA is a stimulating antibody,and may be used in the differential diagnosis of GD and subacute thyroiditis.

关 键 词：TRAB 诊断价值 GRAVES病 甲状腺疾病 

分 类 号：R581.11[医药卫生—内分泌]