血清甲状腺功能指标对Graves病治疗反应性的预测价值  

Prognostic Value of Serum Thyroid Function Index in Treatment Reactivity of Graves Disease

作　　者：李静 徐肖杰 邢慧娟 赵蒙蒙 高率斌 毛雨 霍亚杰 康志强 LI Jing;XU Xiaojie;XING Huijuan;ZHAO Mengmeng;GAO Shuaibin;MAO Yu;HUO Yajie;KANG Zhiqiang(Endocrinology Department,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China)

机构地区：[1]郑州大学附属郑州中心医院内分泌科,河南郑州450007

出　　处：《河南医学研究》2025年第1期34-38,共5页Henan Medical Research

摘　　要：目的观察毒性弥漫性甲状腺肿(Graves病)患者血清甲状腺功能指标水平预测治疗反应性的价值。方法回顾性选取郑州大学附属郑州中心医院2020年1月至2023年1月收治的73例Graves患者作为观察组,按照1∶1配对原则选取同期、同年龄段在郑州大学附属郑州中心医院进行体检的73例健康者作为对照组。对比两组甲状腺功能指标[游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、甲状腺过氧化物酶抗体(TPOAb)、促甲状腺素(TSH)、甲状腺球蛋白抗体(TGAb)],比较不同病程、促甲状腺素受体抗体(TRAb)活性、治疗反应性患者甲状腺功能各指标水平,用采用受试者工作特征(ROC)曲线下面积(AUC)、净重新分类指数(NRI)、综合判别改善指数(IDI)评估血清甲状腺功能指标对患者治疗反应性的预测价值。结果观察组FT_(4)、FT_(3)、TGAb、TPOAb高于对照组,TSH低于对照组(P<0.05);不同病程、TRAb活性患者FT_(4)、FT_(3)、TSH、TGAb、TPOAb比较,差异均有统计学意义(P<0.05);血清FT_(4)、FT_(3)、TGAb、TPOAb水平与病程、TRAb活性呈正相关,TSH与病程、TRAb活性呈负相关(P<0.05);治疗未反应患者FT_(4)、FT_(3)、TGAb、TPOAb高于治疗反应患者,TSH低于治疗反应患者(P<0.05);FT_(4)、FT_(3)、TGAb、TPOAb与治疗反应性呈正相关,TSH与治疗反应性呈负相关(P<0.05);将FT_(4)、FT_(3)、TSH指标联合作为模型1,TGAb、TPOAb指标联合作为模型2,FT_(4)、FT_(3)、TSH、TGAb、TPOAb指标联合作为模型3,结果显示,模型3预测患者治疗反应的AUC优于模型1、模型2,NRI、IDI分析显示,与模型1、模型2比较,模型3联合预测效果改善明显。结论Graves病患者血清甲状腺功能指标异常表达,且与病程、TRAb活性、治疗反应性密切相关,其各指标联合预测患者治疗反应性具有较高参考价值。Objective To observe the value of serum thyroid function index in predicting treatment reactivity in patients with diffuse toxic goiter(Graves disease).Methods Seventy-three patients with Graves disease admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2020 to January 2023 were retrospectively selected as the observation group,and 73 healthy subjects who underwent physical examination in Zhengzhou Central Hospital Affiliated to Zhengzhou University at the same period and age at the same time were selected as the control group according to the 1∶1 pairing principle.Thyroid function indexes[free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroid peroxidase antibody(TPOAb),thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb)]were compared between the two groups.The levels of thyroid function indexes in patients with different disease course,thyrotropin receptor antibody(TRAb)activity and treatment responsiveness were compared.Receiver operating characteristic(ROC)area under the curve(AUC),net reclassification index(NRI),integrated discrimination improvement(IDI)were used to evaluate the predictive value of serum thyroid function indexes in patients with treatment responsiveness.Results FT_(4),FT_(3),TGAb and TPOAb in observation group were higher than those in control group,and TSH was lower than those in control group(P<0.05).There were significant differences in FT_(4),FT_(3),TSH,TGAb and TPOAb among patients with different disease course and TRAb activity(P<0.05).Serum FT_(4),FT_(3),TGAb and TPOAb levels were positively correlated with disease course and TRAb activity,while TSH was negatively correlated with disease course and TRAb activity(P<0.05).FT_(4),FT_(3),TGAb,TPOAb were higher in patients with non-response than those with response,and TSH was lower than those with response(P<0.05).FT_(4),FT_(3),TGAb and TPOAb were positively correlated with treatment reactivity,while TSH was negatively correlated with treatment reactivity(P<0.05).Combining FT_(4),FT_(3)

关 键 词：毒性弥漫性甲状腺肿 甲状腺功能 治疗反应性 价值 

分 类 号：R581[医药卫生—内分泌]