亚临床甲状腺功能异常患者碘营养状态和自身免疫抗体分析  

Analysis of Iodine Nutritional Status and Autoantibody in Patients with Subclinical Thyroid Dysfunction

作　　者：刘玉枝[1] 邓海荣 王凤玲[1] 侯振江[1] 陈立新[3] LIU Yuzhi;DENG Hairong;WANG Fengling;HOU Zhenjiang;CHEN Lixin(Cangzhou Medical College,Cangzhou 061001,China;Department of FunctionalMedicine,Huanghua Traditional Chinese Medicine Hospital,Huanghua 061100,China;Department of Clinical Laboratory,Cangzhou Traditional Chinese Medicine-WesternMedicine Hospital,Cangzhou 061001,China)

机构地区：[1]沧州医学高等专科学校,河北沧州061001 [2]黄骅市中医医院功能科,河北黄骅061100 [3]沧州中西医结合医院检验科,河北沧州061001

出　　处：《医学综述》2019年第17期3518-3521,共4页Medical Recapitulate

基　　金：河北省省级科技计划自筹经费项目(162777206)

摘　　要：目的分析亚临床甲状腺功能异常患者碘营养状态和甲状腺自身抗体水平。方法选取2015年6月至2017年10月沧州中西医结合医院内分泌科初诊的518例亚临床甲状腺功能异常患者为研究组,依据患者亚临床甲状腺功能异常情况分为亚临床甲状腺功能亢进症(亚临床甲亢)组(242例)和亚临床甲状腺功能减退症(亚临床甲减)组(276例),并选取同期130名健康体检者作为对照组,分别检测各组血清抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)和尿碘,对比研究两组及与对照组阳性率和碘营养状态的差异。结果研究组与对照组尿碘中位数比较差异无统计学意义(P>0.05)。亚临床甲亢组和亚临床甲减组尿碘中位数比较差异无统计学意义(P>0.05)。亚临床甲亢组和亚临床甲减组患者的TGAb、TPOAb、TGAb+TPOAb阳性率均高于对照组[29.6%(72/242)、25.4%(70/276)比12.7%(17/130),23.8%(58/242)、29.3%(81/276)比14.6%(19/130),19.2%(46/242)、22.5%(62/276)比11.1%(14/130)](P<0.05)。亚临床甲亢组、亚临床甲减组、对照组碘营养情况比较差异有统计学意义(P<0.05)。亚临床甲亢患者中碘营养缺乏状态与TPOAb和TGAb滴度呈正相关(r=0.738,P<0.001;r=0.876,P<0.001)。结论自身免疫抗体TPOAb和TGAb及碘营养缺乏和过量是亚临床甲状腺功能异常发病的重要因素。Objective To study the iodine nutritional status and the thyroid autoantibody level in patients with subclinical thyroid dysfunction.Methods From Jun.2015 to Oct.2017,518 patients with subclinical thyroid dysfunction in Cang zhou Traditional Chinese Medicine-Western Medicine Hospital were included in the study,and divided into a subclinical hyperthyroidism group(242 cases)and a subclinical hypothyroidism group(276 cases).130 normal adults for physical examination during the same period were included as a control group.Serum anti-thyroxine globulin antibody(TGAb),anti-thyroid peroxidase antibody(TPOAb)and urine iodine were detected.Differences in positive rate of TGAb,TPOAb and iodine nutritional status of the three groups were compared and analyzed.Results There was no significant difference in median urinary iodine between the study groups and the control group(P>0.05).There was also no difference in median urinary iodine between the subclinical hyperthyroidism group and the subclinical hypothyroidism group(P>0.05).The positive rate of TGAb,TPOAb and TGAb+TPOAb in the subclinical hyperthyroidism group and subclinical hypothyroidism group was significantly higher than that of the control group[29.6%(72/242),25.4%(70/276)vs12.7%(17/130);23.8%(58/242),29.3%(81/276)vs 14.6%(19/130);19.2%(46/242),22.5%(62/276)vs11.1%(14/130)](P<0.05).There was significant difference in iodine nutrition status between the two study groups and the control group(P<0.05).The state of iodine deficiency in patients with subclinical hyperthyroidism was positively correlated with the titer of TPOAb and TGAb(r=0.738,P<0.001;r=0.876,P<0.001).Conclusion The increase of TPOAb,TGAb and the iodine deficiency and iodine excess are important pathogenic factors in subclinical thyroid dysfunction.

关 键 词：尿碘 碘营养状态 自身免疫抗体 亚临床甲状腺功能亢进症 亚临床甲状腺功能减退症 

分 类 号：R581[医药卫生—内分泌]