1935例初发Graves病患者甲状腺激素水平和甲状腺自身抗体滴度水平分析  

Analysis of the thyroid hormone levels and thyroid autoantibody titer levels in 1935 cases with incipient Graves disease

作　　者：于佳[1] 卢泽芬 任丽萍[3] 何庆[4] YU Jia;LU Ze-fen;REN Li-ping;HE Qing(Cardiological Department, Tianjin Haihe Hospital, Tianjin 300050, Chin)

机构地区：[1]天津市海河医院心内科,天津300050 [2]沧州市人民医院内分泌科 [3]天津大学校医室 [4]天津医科大学总医院内分泌科

出　　处：《中国慢性病预防与控制》2018年第3期167-170,共4页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：国家自然科技支撑计划项目(151302055)

摘　　要：目的观察并分析初发Graves病(GD)患者甲状腺激素水平和甲状腺自身抗体滴度水平,为GD的治疗提供依据。方法收集天津医科大学总医院2015年1月至2017年6月内分泌科就诊的1 935例临床确诊初发GD患者资料,入院后次日清晨空腹抽取研究对象肘正中静脉血2 ml,应用化学发光法检测游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)和促甲状腺素受体抗体(TRAb)水平。用SPSS 16.0软件进行统计分析,不符合正态分布的计量资料用中位数(P25,P25)表示,组间比较用秩和检验;相关性分析用Spearman法;影响因素分析用多元线性回归分析。结果 1 935例初发GD患者的年龄中位数为38岁(P25,P75:28,52岁),FT3中位数为14.39 pmol/L(P25,P75:10.80,21.49 pmol/L),FT4中位数为42.41 pmol/L(P25,P75:33.60,56.34 pmol/L),TSH中位数为0.008μIU/ml(P25,P75:0.006,0.011μIU/ml),TRAb中位数为8.08 IU/ml,(P25,P75:3.36,21.88 IU/ml),TPOAb中位数为304.00 IU/ml(P25,P75:46.70,1000.00 IU/ml),TGAb中位数为34.60 IU/ml(P25,P75:20.00,202.00 IU/ml)。TRAb阳性率为99.90%,TPOAb阳性率为84.55%,TGAb阳性率为47.49%,TPOAb在不同滴度水平均有分布,滴度水平超过1 000IU/ml的病例占26.15%。男性患者发病年龄明显高于女性,血清中FT3、FT4、TRAb水平均明显高于女性,差异均有统计学意义(P<0.05,P<0.01)。FT3、FT4与TRAb、TPOAb均呈明显的正相关(r值分别为0.255、0.209、0.094和0.114,P<0.05,P<0.01),TSH与TRAb、TPOAb均呈明显的负相关(r值分别为-0.091、-0.056,P<0.05,P<0.01)。FT3、FT4对TRAb、TPOAb的影响均有统计学意义(P<0.05,P<0.01),且均为正向影响,表明FT3、FT4都会随TRAb、TPOAb的增加而增加。结论初发GD患者的甲状腺激素水平明显升高,临床医生应根据GD患者甲状腺激素水平和甲状腺抗体滴度水平,合理选择GD的治疗方案和抗甲状腺药物的使用剂量和疗程。同时注�Objective To observe the thyroid hormone levels and the thyroid autoantibody titer levels in patients with incipient Graves disease（GD） and to provide the basis for treating GD. Methods The date of 1 935 cases with incipient GD in the outpatients of the endocrinology department of in Tianjin Medical University General Hospital were collected from January of 2015 to June of 2017. All patients were clinically diagnosed as incipient GD, 2 ml of venous blood was drawn on an empty stomach early in the morning, and the levels of FT4, FT3, TSH, TPOAb, TGAb and TRAb were detected by chemiluminescence method. SPSS 16.0 software was used for statistical analysis, the metering data that do not meet the normal distribution were compared with rank-sum test. Spearman method was used for correlation analysis. Multiple linear regression analysis was used for influencing factor analysis. Results The median levels of age, FT3, FT4, TSH, TRAb, TPOAb and TGAb among the 1 935 cases with incipient GD were 38 years old（P25, P75： 28, 52 years old）, 14.39 pmol/L（P25, P75： 10.80, 21.49 pmol/L）, 42.41 pmol/L（P25, P75： 33.60, 56.34 pmol/L）, 0.008 μIU/ml（P25, P75： 0.006, 0.011 μIU/ml）, 8.08 IU/ml（P25, P75： 3.36, 21.88 IU/ml）, 304.00 IU/ml（P25, P75： 46.70,1 000.00 IU/ml） and 34.60 IU/ml（P25, P75： 20.00, 202.00 IU/ml）, respectively. The positive rates of TRAb, TGAb and TPOAb were 99.90%, 47.49% and 84.55%, respectively; TPOAb distributed at various titer levels, and the proportion of cases with the titer level 1 000 IU/ml was 26.15%. The age of onset of the male patients was significantly higher than that of the female patients, and the serum FT3, FT4 and TRAb levels were significantly higher than those in the female（P〈0.05）. FT3 and FT4 were positively correlated with the TRAb and TPOAb（r values were 0.255, 0.209, 0.094 and 0.114, respectively, P〈0.01 or P〈0.05）. TSH was negatively correlated with TRAb and TPOAb（r values were-0.091,-0.056, respectively, P〈0.01 or P〈0.05）. C

关 键 词：初发Graves病 甲状腺激素 自身抗体 

分 类 号：R581.1[医药卫生—内分泌]