体检人群甲状腺自身抗体与抗谷氨酸脱羧酶抗体的相关性研究  

Association of Thyroid Autoantibody and Anti-glutamic Acid Decarboxylase Antibody in Physical Examinees

作　　者：李婧[1] 邓垂文[2] 徐腾达[1] LI Jing;DENG Chuiwen;XU Tengda(Health Science Department,Peking Union Medical College Hospital,Beijing 100730,China;Rheumatology and Immunology Department,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]北京协和医院健康医学部,北京市100730 [2]北京协和医院风湿免疫科,北京市100730

出　　处：《中国全科医学》2021年第18期2285-2290,共6页Chinese General Practice

摘　　要：背景自身免疫性甲状腺疾病和自身免疫性糖尿病常同时存在,而自身免疫性糖尿病患者继发甲状腺抗体(TA)阳性的风险升高。目的研究我国体检人群中TA与抗谷氨酸脱羧酶抗体(GADA)的关系。方法检索北京协和医院健康管理数据库,查询2012-2015年在北京协和医院进行健康体检并检测GADA和TA的人群,收集其体检资料和GADA、促甲状腺激素、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)水平,其中TPOAb、TgAb任一阳性记为TA阳性。比较TA阳性与阴性人群GADA阳性率,糖尿病与非糖尿病人群TA、GADA阳性率;分析GADA阴性、低滴度、高滴度人群的一般资料,探究体检人群TA阳性、TPOAb阳性、TgAb阳性的影响因素。结果共36048例体检人群符合纳入标准,其中TA阳性5000例(13.9%)[TPOAb阳性3321例(9.2%)、TgAb阳性3552例(9.9%)],TA阴性31048例(86.1%);符合糖尿病诊断2600例(7.2%),不符合33448例(92.8%);GADA阳性185例(0.5%),GADA阴性35863例(99.5%)。TA阳性人群中GADA阳性率[51例(1.0%)]高于TA阴性人群[134例(0.4%)](χ^(2)=29.203,P<0.001)。糖尿病人群中TA阳性率[280例(10.8%)]低于非糖尿病人群[4720例(14.1%)],GADA阳性率[31例(1.2%)]高于非糖尿病人群[154例(0.5%)](χ^(2)值分别为22.558、25.310,P<0.001)。GADA阴性、低滴度、高滴度体检人群中TA阳性率逐步递增(分别是13.8%、23.7%、39.1%)(P<0.05)。多因素Logistic回归分析结果显示:年龄[OR=1.015,95%CI(1.012,1.018)]、性别[女:OR=3.483,95%CI(3.259,3.723)]、糖尿病[是:OR=0.837,95%CI(0.731,0.958)]、GADA[低滴度:OR=1.900,95%CI(1.266,2.853);高滴度:OR=4.259,95%CI(2.260,8.025)]是体检人群TA阳性的影响因素(P<0.05)。结论我国体检人群中GADA阳性率较低,GADA阳性与TA阳性存在相关性。Background Autoimmune thyroid disease and autoimmune diabetes often exist simultaneously.The frequency of thyroid autoantibody(TA)is higher in autoimmune diabetes patients.Objective To investigate the association of anti-glutamic acid decarboxylase autoantibody(anti-GADA)and TA in Chinese physical examinees.Methods The PUMCH Health Management database was searched for physical examinees who had their anti-GADA and TA tested from 2012 to 2015.The results of anti-GADA,thyroid stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb)and thyroglobulin antibody(TgAb)and other data were collected.TA positive was defined as TPOAb positive or TgAb positive.Prevalence of anti-GADA was compared between TA positive and TA negative subjects,and also between diabetic and nondiabetic subjects.Clinical characteristics were compared among subjects with anti-GADA negative,anti-GADA low titer and anti-GADA high titer.Risk factors of TA positivity,TPOAb positivity and TgAb positivity were analyzed by multivariate Logistic regression.Results There were 36048 eligible participants totally,among whom 5000(13.9%)were TA positive〔3321(9.2%)were TPOAb positive;3552(9.9%)were TgAb positive〕and 31048(86.1%)were TA negative;2600(7.2%)met the diagnostic criteria of diabetes and 33448(92.8%)did not;185(0.5%)were anti-GADA positive and 35863(99.5%)were anti-GADA negative.The prevalence of anti-GADA in TA positive subjects(n=51,1.0%)was significantly higher than that in TA negative subjects(n=134,0.4%)(χ^(2)=29.203,P<0.001).The prevalence of TA positivity was lower in diabetic subjects(n=280,10.8%)than that in nondiabetic ones(n=4720,14.1%)(χ^(2)=22.558,P<0.001).The prevalence of anti-GADA is higher in diabetic subjects(n=31,1.2%)than that in nondiabetic ones(n=154,0.5%)(χ^(2)=25.310,P<0.001).The frequency of TA raised from anti-GADA negative group to anti-GADA low titer group to anti-GADA high titer group(13.8%,23.7%,39.1%,respectively,P<0.05).In the multivariate Logistic regression,age〔OR=1.015,95%CI(1.012,1.018)〕,sex〔female:OR

关 键 词：糖尿病 甲状腺疾病 抗谷氨酸脱羧酶抗体 甲状腺自身抗体 影响因素分析 

分 类 号：R581[医药卫生—内分泌] R587.1[医药卫生—内科学]