游离甲状腺激素及自身抗体在Graves病与破坏性甲状腺毒症鉴别中的应用价值  

Application value of free thyroid hormone and autoantibody in differentiating Graves’ disease from destructive thyrotoxicosis

作　　者：李雪[1] 王镁[2] 张明瑞 赵鹏鹏 孙滢 单雪薇 田若粒 陈方旭 LI Xue;WANG Meiy ZHANG Mingrui(Graduate School,Liaoning University of Traditional Chinese Medicine,Shenyang 110032,CHINA)

机构地区：[1]辽宁中医药大学研究生学院,辽宁沈阳110032 [2]辽宁中医药大学附属医院内分泌科

出　　处：《江苏医药》2022年第2期165-168,F0002,共5页Jiangsu Medical Journal

摘　　要：目的探讨血清游离甲状腺激素及自身抗体在Graves病与破坏性甲状腺毒症鉴别中的应用价值。方法196例甲状腺毒症患者根据病因分为初诊Graves病组(142例)与破坏性甲状腺毒症组(54例),比较两组患者游离甲状腺激素、TSH及自身抗体。绘制ROC曲线分析各指标在鉴别Graves病和破坏性甲状腺毒症中的价值。结果初诊Graves病组患者FT3、FT4、FT3/FT4比值、促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体水平均高于破坏性甲状腺毒症组(P<0.05),而TSH水平低于破坏性甲状腺毒症组,差异有统计学意义(P<0.05)。绘制ROC曲线结果显示,TRAb诊断Graves病的曲线下面积最大为0.987[95%CI(0.973~1.000)],当取0.92 IU/L为最佳诊断界值时,诊断Graves病的灵敏度为95.5%,特异度为98.1%;其次为FT3/FT4比值,其曲线下面积为0.888[95%CI(0.840~0.937)],当取0.35为最佳诊断界值时,诊断Graves病的灵敏度为72.5%,特异度为90.7%。结论在无法进行甲状腺131碘摄取率检查的情况下,TRAb可作为初诊Graves病与破坏性甲状腺毒症鉴别诊断的首选指标,FT3/FT4比值作为一个新的鉴别指标可用于辅助临床鉴别诊断。Objective To explore the application value of serum free thyroid hormones and autoantibodies in the differentiation of Graves’ disease from destructive thyrotoxicosis.Methods A total of 196 patients with thyrotoxicosis were divided into two groups of A(newly diagnosed Graves’ disease, 142 cases) and B(diagnosed destructive thyrotoxicosis, 54 cases) according to the etiology.Serum levels of free thyroid hormone, TSH and autoantibodies were compared between the two groups.ROC curve was used to analyze the diagnostic value of each index in distinguishing Graves’ disease from destructive thyrotoxicosis.Results Serum levels of FT;,FT;,FT;/FT;ratio, TSH receptor antibody(TRAb) and anti-thyroid peroxidase antibody in group A were higher than those in group B(P<0.05),while the TSH level was lower than that of group B(P<0.05).The results of ROC curve showed that the maximum area values under the curve for TRAb and FT;/FT;ratio to diagnose Graves’ disease were 0.987 [95%CI(0.973-1.000)] and 0.888 [95%CI(0.840-0.937)],respectively.Taking TRAb 0.92 IU/L as the best cut-off threshold, the sensitivity and specificity of TRAb in diagnosing Graves’ disease were 95.5% and 98.1%.Taking FT;/FT;ratio 0.35 as the best cut-off threshold, the sensitivity and specificity of FT;/FT;ratio in diagnosing Graves’ disease were 72.5% and 90.7%.Conclusion When the thyroid;I ablation can not be performed, TRAb can be used as the first-choice of indicator for the differential diagnosis of newly diagnosed Graves’ disease from destructive thyrotoxicosis, and the FT;/FT;ratio can be used as a new differential indicator to assist clinical differential diagnosis.

关 键 词：GRAVES病 破坏性甲状腺毒症 游离三碘甲状腺原氨酸 游离甲状腺素 促甲状腺激素受体抗体 

分 类 号：R581[医药卫生—内分泌]