4项甲状腺自身抗体的变化特征及联合半定量评分在格雷夫斯甲亢^(131)I治疗后疗效的相关性评估中的临床应用价值  

The variation characteristics of four thyroid antibodies and the value of the combined semiquantitative scores in the evaluation of the efficacy of Graves'hyperthyroidism after^(131)I therapy

作　　者：管樑[1] 陈刚[1] Guan Liang;Chen Gang(Department of Nuclear Medicine,Shanghai Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院核医学科,上海200025

出　　处：《国际放射医学核医学杂志》2023年第12期746-751,共6页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的评估甲状腺球蛋白抗体(TgAb)、促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)和促甲状腺激素受体刺激性抗体(TSAb)的变化特征及联合半定量评分在格雷夫斯甲亢(GH)^(131)I治疗后疗效中的临床应用价值。方法回顾性分析2000年1月至2021年8月在上海交通大学医学院附属瑞金医院行^(131)I治疗的512例GH患者的临床资料,其中男性101例、女性411例,年龄(38±12)岁。根据疗效评估结果将^(131)I治疗后的患者分为4组:甲状腺功能减退(简称甲减)组、完全缓解组、部分缓解组和无效组;前3组为有效组(A组),共431例,无效组(B组)81例。根据^(131)I治疗后的时间将A组分成4小组:A1组(^(131)I治疗后1年内),80例;A2组(^(131)I治疗后1~4年),193例;A3组(^(131)I治疗后5~9年),90例;A4组(^(131)I治疗后10年以上),68例。入组的GH患者均于^(131)I治疗后的第4周、第7周、第3个月、第6个月、第12个月或逐年进行游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素、TgAb、TRAb、TPOAb、TSAb水平的连续、联合测定。单项甲状腺抗体和TgAb、TRAb、TPOAb和TSAb 4项甲状腺抗体联合半定量评分范围分别为0~3分和0~12分。组间的比较采用配对t检验。结果^(131)I治疗后TgAb、TRAb、TPOAb和TSAb水平会有不同程度地升高,其中异常升高的状况可以分别持续29、21、26和26个月,之后会有不同程度地下降(直至阴性)。B组、A1组、A2组、A3组和A4组患者的4项甲状腺抗体联合半定量评分分别为(7.43±2.31)、(5.41±2.23)、(4.43±2.40)、(2.15±1.99)和(1.52±1.50)分;A1组与A2组、A2组与A3组、A3组与A4组、A1组与B组的组间比较,差异均有统计学意义(t=3.237、8.358、2.252、−5.639,均P<0.05)。在^(131)I治疗后5年、10年以上,TPOAb、TgAb、TRAb、TSAb的阳性率分别为64.56%(102/158)和55.88%(38/68),34.81%(55/158)和33.82%(23/68)、18.35%(29/158)和11.76%(8/68)、24.68%(39/158)和17.65%(12/68)。结论4Objective To evaluate the characteristics of changes in thyroglobulin antibody(TgAb),thyroid stimulating hormone receptor antibody(TRAb),thyroid peroxidase antibody(TPOAb)and thyroid stimulating antibody(TSAb)and the value of the combined semi-quantitative score in assessing the effectiveness of^(131)I treatment for Graves'hyperthyroidism(GH).Methods Retrospective analysis of clinical data of 512 patients with GH who underwent^(131)I treatment at Shanghai Ruijin Hospital,School of Medicine,Shanghai JiaoTong University from January 2000 to August 2021.The patients comprised 101 males and 411 females,aged(38±12)years.According to the efficacy evaluation,patients treated with^(131)I were divided into four groups:hypothyroidism group,complete remission group,partial remission group,and ineffective group.The first three groups were the effective group(Group A)with a total of 431 cases,and the ineffective group(Group B)had 81 cases.According to the time after^(131)I treatment,Group A was further divided into 4 groups:Group A1(within 1 year after^(131)I treatment;80 cases);Group A2(1−4 years after^(131)I treatment;193 cases),Group A3(5−9 years after^(131)I treatment;90 cases);Group A4(more than 10 years after^(131)I treatment;68 cases).The GH patients enrolled in the study underwent continuous and combined measurements of free triiodothyronine,free thyroxine,thyroid stimulating hormone,TgAb,TRAb,TPOAb,and TSAb levels were performed at 4 weeks,7 weeks,3 months,6 months,12 months,or annually after^(131)I treatment.The semi-quantitative score ranges for single and four combined thyroid antibodies(TgAb,TRAb,TPOAb and TSAb)were 0–3 and 0–12 points,respectively.The intergroup differences were compared using paired t-test.Results TgAb,TRAb,TPOAb,and TSAb increased to varying degrees after^(131)I treatment,and the abnormal increase period could last for 29,21,26,and 26 months,respectively.Thereafter,they exhibited different degrees of decline(until it could be negative).In group B,A1,A2,A3 and A4,the combined semi-quan

关 键 词：格雷夫斯病 甲状腺功能亢进症 碘放射性同位素 免疫球蛋白类 甲状腺刺激 半定量评分 

分 类 号：R581.1[医药卫生—内分泌]