血清TPOAb检测在亚临床甲状腺功能减退患者诊治中的应用  

Detection of serum thyroid peroxidase antibody in the diagnosis and treatment of subclinical hypothyroidism

作　　者：刘颖[1] 王楠 高蕾[1] 

机构地区：[1]北京市昌平区中西医结合医院内分泌科,北京102208

出　　处：《中国临床研究》2018年第1期91-94,共4页Chinese Journal of Clinical Research

基　　金：北京市昌平区中西医结合医院院级科研项目(YJXM-20160003)

摘　　要：目的探讨血清甲状腺过氧化酶抗体(TPOAb)在亚临床甲状腺功能减退(甲减)患者临床诊断及预后评估中的价值。方法采用回顾性分析方法,选取2014年1月至2015年1月180例确诊亚临床甲减患者,按TPOAb水平分为TPOAb阳性亚组76例和阴性亚组104例,并选同期健康受试者160例作为对照组。在禁食>8 h的安静状态下,对照组一次、研究组患者治疗前(所有亚临床甲减患者在获首次检测结果后均行抑制性治疗)及治疗后两次抽取空腹静脉血,检测血清TPOAb及甲状腺激素[血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)]和血脂代谢指标[血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和甘油三酯(TG)]水平。对比两亚组患者治疗前后血清TPOAb、TSH、FT3、FT4、TG、TC、LDL-C水平的变化,并与对照组比较;观察两亚组患者治疗后发展为甲减及甲状腺功能改善情况。结果 (1)与对照组比较,亚临床甲减患者的血清TSH、TG、TC、LDL-C水平明显增高(P均<0.01),TPOAb阳性率明显上升(P<0.01),而血清FT3、FT4水平相当(P均>0.05)。(2)TPOAb阳性和阴性亚组治疗前FT3、FT4、TSH、TG、TC、LDL-C水平相近(P均>0.05)。与治疗前比较,两亚组患者治疗后TG、LDL-C水平无明显变化(P均>0.05),而FT3、FT4、TSH、TC水平显著下降(P均<0.05),但各指标治疗后组间比较差异均无统计学意义(P均>0.05)。(3)随访1年后,TPOAb阴性亚组亚临床甲减无变化为50.96%,进展为甲减0.96%,进展为甲状腺功能亢进症(甲亢)0.96%,甲状腺功能正常47.12%。TPOAb阳性亚组亚临床甲减无变化27.64%,进展为甲减5.26%,进展为甲亢2.63%,甲状腺功能正常64.47%。TPOAb阳性亚组仍然甲减率明显低于TPOAb阴性亚组(P<0.01),甲状腺功能正常率明显高于TPOAb阴性亚组(P<0.05)。结论亚临床甲减患者存在较高的TPOAb水平,可作为亚临床甲减患者诊断时的指示指标,不同TPOAb水平患者的临床预Objective To investigate the value of serum thyroid peroxidase antibody （TPOAb）in the clinical diagnosis and prognosis evaluation of subclinical hypothyroidism. Methods Using the retrospective analysis method, 180 patients with subclinical hypothyroidism confirmed from January 2014 to January 2015 were selected as experiment group, which was divided into TPOAb positive subgroup （n = 76 ） and negative subgroup（ n = 104） according to serum TPOAb level. At the same time, 160 healthy subjects were served as control group. All the patients with subclinical hypothyroidism received inhibitory therapy for the first time. After the patients and subjects were fasted for more than 8 hours and were in the quiet state, fasting venous blood serum levels of TPOAb, thyroid stimulating hormone （TSH） , free triiodothyronine （ FT3 ） , free thyroid hormone （FT4）, serum total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C） and triglyceride （TG） were detected one time in control group and two times in experiment group（ before and after treatment）. The serum levels of TPOAb, TSH, FT3, FT4, TG, TC and LDL-C were compared between the two subgroups before and after treatment, and then they were compared with control group. The hypothyroidism and improvement of thyroid function after treatment in both two subgroups were observed. Results Compared with control group, the levels of serum TSH,TG,TC, LDL-C and TPOAb positive rate significantty increased in experiment group（ all P 〉 0.01 ） , while the levels of serum FT3 and FT4 were similar between two groups （all P 〉 0.05 ）. Before treatment, there were no significant differences in serum FT3, FT4 TSH, TG,TC, LDL-C levels between two subgroups （ all P 〉 0.05 ）. Compared with pre-treatment, there were no obvious changes in the levels of TC, LDL-C （ all P 〉 0.05 ）, and the levels of FT3, FT4, TSH, TC significantly decreased （ all P 〈 0.05 ） in both two subgroups after treatment. However, there were no significan

关 键 词：甲状腺过氧化酶抗体 甲状腺功能减退症 亚临床 甲状腺功能亢进症 预后 

分 类 号：R581.2[医药卫生—内分泌]