甲状腺相关抗体及高分辨超声对甲状腺功能正常桥本甲状腺炎诊断效能的对比  

Comparison of diagnostic performance of thyroid autoantibodies and high-resolution ultrasound in euthyroid Hashimoto's thyroiditis

作　　者：胡永莲 李霄[2] 方海生[2] 叶新华[3] 沈美萍[4] 武晓泓 Hu Yonglian;Li Xiao;Fang Haisheng;Ye Xinhua;Shen Meiping;Wu Xiaohong(Department of Endocrinology,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Pathology,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Ultrasound,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Endocrinology,Zhejiang Provincial People's Hospital,People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]南京医科大学第一附属医院内分泌科,南京210029 [2]南京医科大学第一附属医院病理科,南京210029 [3]南京医科大学第一附属医院超声诊断科,南京210029 [4]南京医科大学第一附属医院普外科,南京210029 [5]浙江省人民医院杭州医学院附属人民医院内分泌科,杭州310014

出　　处：《中华医学杂志》2021年第32期2537-2543,共7页National Medical Journal of China

摘　　要：目的评估甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)和高分辨超声(HRUS)诊断甲状腺功能正常桥本甲状腺炎(HT)的效能。方法收集2016年1月至2019年1月在南京医科大学第一附属医院行甲状腺手术患者的术前甲状腺功能、TPOAb、TgAb及HRUS资料,以组织病理学(HP)检查结果作为金标准,比较各项指标在HT诊断中的效能。结果最终纳入792例患者,其中男217例、女575例,年龄的M(Q1,Q3)为41(32,52)岁(16~75岁)。以HP为金标准,TPOAb与TgAb诊断HT的灵敏度(59.3%比61.2%,P=0.752)、准确性(85.0%比83.6%,P=0.379)以及受试者工作特征曲线下面积(AUC)(0.767比0.764,P=0.886)差异均无统计学意义,但TPOAb具有更高的特异度(94.2%比91.6%,P=0.033);两者均有高于HRUS的灵敏度(59.3%比44.5%,P=0.002;61.2%比44.5%,P<0.001)、准确性(85.0%比79.7%,P=0.001;83.6%比79.7%,P=0.013)和AUC(0.767比0.684,P<0.001;0.764比0.684,P<0.001)。与单一指标相比,TPOAb联合TgAb或HRUS均可提高诊断的灵敏度和AUC,三者联合诊断HT的灵敏度最高(均P<0.05)。TPOAb与HP在诊断HT方面具有中度一致性(Kappa值=0.580,95%CI:0.513~0.647,P<0.001)。结论TPOAb联合TgAb可提高诊断甲状腺功能正常HT的灵敏度和准确性,两种抗体与HRUS联合诊断效能最大,TPOAb与HP诊断HT具有中度一致性。Objective To compare the diagnostic performance of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb)and high-resolution ultrasound(HRUS)in euthyroid Hashimoto's thyroiditis(HT).Methods From January 2016 to January 2019,patients with complete data of preoperative thyroid function,TPOAb,TgAb and HRUS who had undergone thyroid surgery treatment at the First Affiliated Hospital with Nanjing Medical University were reviewed.The diagnostic value of different diagnostic methods was compared using histopathology(HP)examination result as the gold standard.Results The data of 792 patients(217 males and 575 females)was retrospectively collected.The M(Q1,Q3)of patients'age was 41(32,52)years and the range was 16-75 years.With HP as the diagnostic gold standard,TPOAb exhibited similar sensitivity(59.3%vs 61.2%,P=0.752),accuracy(85.0%vs 83.6%,P=0.379),area under the receiver operating characteristic curve(AUC)(0.767 vs 0.764,P=0.886)and higher specificity(94.2%vs 91.6%,P=0.033)when compared with TgAb in diagnosing euthyroid HT.They both exhibited a higher sensitivity(59.3%vs 44.5%,P=0.002;61.2%vs 44.5%,P<0.001),accuracy(85.0%vs 79.7%,P=0.001;83.6%vs 79.7%,P=0.013)and AUC(0.767 vs 0.684,P<0.001;0.764 vs 0.684,P<0.001)than HRUS.Compared with each method alone,the sensitivity and AUC of TPOAb combined with TgAb or HRUS were improved.The combination of three methods showed the greatest sensitivity.Concordance analysis demonstrated that TPOAb and HP had a moderate agreement(Kappa=0.580,95%CI:0.513-0.647,P<0.001).Conclusions The combination of thyroid antibodies,TPOAb and TgAb,can improve sensitivity,accuracy and AUC of diagnosis in euthyroid Hashimoto's thyroiditis.The two antibodies combined with HRUS exhibited the highest diagnostic performance.Elevated TPOAb showed moderate diagnostic consistency with histopathologic evidence of HT.

关 键 词：桥本病 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 高分辨超声 诊断效能 诊断试验 

分 类 号：R581.4[医药卫生—内分泌]