第3代促甲状腺素受体抗体测定法(Elecsys)对甲状腺毒血症的鉴别诊断价值  

Clinical value of 3^(rd) generation assay of thyroid stimulating hormone receptor antibody(Elecsys)for differential diagnosis of thyrotoxicosis

作　　者：陈立立 俞一飞 曾芳芳 赵晓龙 李益明 刘红 CHEN Li-li;YU Yi-fei;ZENG Fang-fang;ZHAO Xiao-long;LI Yi-ming;LIU Hong(Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai 200040, China)

机构地区：[1]复旦大学附属华山医院内分泌科,上海200040

出　　处：《中国临床医学》2021年第1期80-84,共5页Chinese Journal of Clinical Medicine

基　　金：上海市卫生和计划生育委员会研究课题(20154Y0013).

摘　　要：目的:探讨第3代促甲状腺素受体抗体(TRAb)检测方法——电化学发光法(Elecsys)对甲状腺毒血症病因鉴别的诊断价值。方法:回顾性选取2016年1月至2018年5月复旦大学附属华山医院收治的未经治疗的甲状腺毒血症患者154例,测定其甲状腺功能、TRAb、甲状腺摄碘率和甲状腺上动脉收缩期峰值流速(peak systolic velocity of superior thyroid artery,STA-PSV)。采用ROC曲线比较第3代TRAb及STA-PSV对Graves病(Graves’disease,GD)和破坏性甲状腺炎(destructive thyroiditis,DT)的鉴别诊断价值。结果:154例甲状腺毒血症患者中,女性111例(72.0%),平均年龄38.42岁,GD 117例(76.0%)。TRAb的AUC为0.984(95%CI 0.967~1.000),优于STA-PSV(AUC 0.903,95%CI 0.839~0.967)。TRAb的最佳切割点为1.7 U/L,区分GD和DT的灵敏度和特异度为94.8%和94.3%。TRAb切割点为3.6 U/L时,其鉴别GD/DT的特异度和阳性预测值均为100%。结论:第3代TRAb检测(Elecsys)对甲状腺毒症的病因鉴别具有较高的灵敏度和特异度。Objective:To explore the applicability of 3^(rd) generation thyroid stimulating hormone receptor antibody(TRAb)assay(Elecsys)in clinical differentiation of thyrotoxicosis.Methods:154 subjects with untreated thyrotoxicosis,who were admitted to Huashan Hospital between January 2016 and May 2018 were retrospectively selected.Thyroid function,TRAb,radioactive iodine uptake(RAIU),and mean peak systolic velocity of superior thyroid artery(STA-PSV)were detected.Receiver operating characteristic(ROC)curves were plotted to compare the value of the third generation TRAb and STA-PSV in the differential diagnosis of Graves’disease(GD)and destructive thyroiditis(DT).Results:Of the 154 subjects with untreated thyrotoxicosis enrolled,111(72.0%)were female,their mean age were 38.42 years.Totally,117(76.0%)were diagnosed as GD.The area under the ROC curve for TRAb in the differential diagnosis of thyrotoxicosis was 0.984(95%CI 0.967-1.000),superior to that of STA-PSV(AUC 0.903,95%CI 0.839-0.967).The best cutoff point of TRAb was 1.7 U/L,the sensitivity and specificity in distinguishing GD from DT were 94.8%and 94.3%,respectively.If TRAb cutoff point was set 3.6 U/L,its specificity and postive predictive value in GD differentiation reached 100%.There are 5 TRAb negative(<1.7 U/L)GD cases,all of whom have significantly elevated STA-PSV.Conclusions:The 3^(rd) generation TRAb assay(Elecsys)is sensitive and specific in the differential diagnosis of thyrotoxicosis.

关 键 词：第3代TRAb检测 电化学发光法 甲状腺毒血症 鉴别诊断 

分 类 号：R581[医药卫生—内分泌]