血清游离三碘甲状腺原氨酸游离甲状腺素及两者比值在甲状腺毒症病因鉴别诊断中的价值  

Clinical significance of serum FT3,FT4 and FT3/FT4 values in differentiating the causes of thyrotoxicosis.

作　　者：彭彩 仇安琪 张冬梅[2] 雷闽湘[2] PENG Cai;QIU An-qi;ZHANG Dong-mei;LEI Min-xiang(Department of Endocrinology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]湘雅常德医院内分泌科,湖南常德415000 [2]中南大学湘雅医院内分泌科,湖南长沙410008

出　　处：《中国实用内科杂志》2021年第2期124-128,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81670788)。

摘　　要：目的探讨游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及FT3/FT4值在甲状腺毒症病因鉴别诊断中的价值,为甲状腺毒症病因鉴别提供一项简单实用的临床参考指标。方法回顾性分析2017年10月至2019年11月在中南大学湘雅医院新诊断的326例甲状腺毒症患者的临床资料,根据病因分为Graves病组(203例)和破坏性甲状腺毒症组(包括亚急性甲状腺炎96例和桥本甲状腺炎27例,共123例)。计算FT3/FT4值,比较两组间FT3、FT4以及FT3/FT4值的差异,分析促甲状腺素受体抗体(TRAb)和FT3、FT4及FT3/FT4的相关性。采用受试者工作曲线(ROC)评价这些临床指标对甲状腺毒症病因鉴别诊断的临床价值。随机抽取不在实验数据范围内的初治甲状腺毒症患者,计算FT3/FT4值进行验证。结果(1)Graves病组的FT3、FT4、FT3/FT4值显著高于破坏性甲状腺毒症组(P<0.01);(2)ROC曲线分析显示,FT3、FT4和FT3/FT4诊断Graves病的切点值分别是18.89 pmol/L、54.99 pmol/L和0.3378。当FT3/FT4=0.3378,此时敏感度和特异度分别为0.793和0.813,阳性预测值和阴性预测值分别是87.5%和70.4%,可作为临床上Graves病和破坏性甲状腺毒症的诊断截点;(3)甲状腺毒症患者FT3、FT4、FT3/FT4与TRAb均呈显著正相关(P<0.01);(4)将随机抽取的甲状腺毒症患者的FT3/FT4进行验证,得出的诊断结果与实际结果高度一致。结论FT3、FT4以及FT3/FT4有助于甲状腺毒症病因鉴别诊断,FT3/FT4=0.3378可用于临床鉴别Graves病与破坏性甲状腺毒症。Objective To explore the value of FT3,FT4 and FT3/FT4 in the differential diagnosis of the causes of thyrotoxicosis. Methods Clinical data of 326 cases of newly diagnosed thyrotoxicosis from Oct. 2017 to Dec. 2019 in Xiangya Hospital were collected. According to the etiology,they were divided into Graves disease group(n=203)and destructive thyrotoxicosis group(n=123,including 96 cases of subacute thyroiditis and 27 cases of Hashimoto’s thyroiditis).Serum FT3,FT4 and FT3/FT4 were compared between groups. Correlations between TRAb and FT3,FT4 and FT3/FT4 were analyzed. The receiver operating curve(ROC curve)was used to evaluate the diagnostic value of these clinical indicators for the differentiation of the cause of thyrotoxicosis. The newly diagnosed thyrotoxicosis that was not within the scope of this experimental data was randomly selected,and the FT3/FT4 value was calculated for verification. Results Serum FT3,FT4 and FT3/FT4 in Graves disease group were significantly higher than those in destructive thyrotoxicosis group(P<0.01). ROC curve analysis showed that the cut-off values of FT3,FT4 and FT3/FT4 for diagnosis of Graves disease were 18.89 pmol/L,54.99 pmol/L and 0.3378,respectively. When FT3/FT4= 0.3378,the sensitivity and specificity are 0.793 and 0.813,respectively,and the positive predictive value and negative predictive value were 87.5% and 70.4%,respectively,which could be used as the diagnosis cut-off point of Graves disease and destructive thyrotoxicosis clinically Serum FT3,FT4,FT3/FT4 were positively correlated with TRAb with significance(P<0.01). The FT3/FT4 of randomly selected patients with thyrotoxicosis were verified,and the diagnosis results were highly consistent with the actual results. Conclusion FT3,FT4 and FT3/FT4 are helpful for the differential diagnosis of the cause of thyrotoxicosis.The FT3/FT4 value being 0.3378 can be used to clinically distinguish between Graves disease and destructive thyrotoxicosis.

关 键 词：甲状腺毒症 GRAVES病 破坏性甲状腺毒症 诊断 ROC曲线 

分 类 号：R581[医药卫生—内分泌]