[1]娜仁其木格 李冬梅 忻荣荣 贾海英 郑雁红.低滴度TRAb原发性甲状腺毒症患者TRAb 水平与甲状腺131I摄取率的相关性研究[J].国际内分泌代谢杂志,2020,40(03):159-162.[doi:10.3760/cma.j.issn.1673-4157.2020.03.004]
　Na Renqimuge,Li Dongmei,Xin Rongrong,et al.Association between TRAb level and thyroid iodine uptake rate in primary thyrotoxic patients with low titer TRAb[J].International Journal of Endocrinology and Metabolism,2020,40(03):159-162.[doi:10.3760/cma.j.issn.1673-4157.2020.03.004]
点击复制

低滴度TRAb原发性甲状腺毒症患者TRAb 水平与甲状腺131I摄取率的相关性研究()
分享到：

《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
40
期数:
2020年03期
页码:
159-162
栏目:
短篇论著
出版日期:
2020-05-20

文章信息/Info

Title:
Association between TRAb level and thyroid iodine uptake rate in primary thyrotoxic patients with low titer TRAb
作者:
娜仁其木格1 李冬梅1 忻荣荣2 贾海英1 郑雁红2
1内蒙古自治区人民医院内分泌科,呼和浩特 010010; 2内蒙古医科大学,呼和浩特 010010
Author(s):
Na Renqimuge1;  Li Dongmei1;  Xin Rongrong2;  Jia Haiying1;  Zheng Yanhong2
1Department of Endocrinology and Metabolism, Inner Mogolia People's Hospital, Hohhot 010010, China; 2Inner Mongolia Medical University, Hohhot 010010, China
关键词:
甲状腺毒症;  促甲状腺激素受体抗体;  131I摄取率
Keywords:
Thyrotoxicosis;  Thyrotropin receptor antibody;  Thyroid iodine uptake rate
DOI:
10.3760/cma.j.issn.1673-4157.2020.03.004
摘要:
目的 研究无特异性临床表现、低滴度促甲状腺激素受体抗体(TRAb)的原发性甲状腺毒症患者中,TRAb水平与甲状腺131I摄取率的相关性。方法 选取初诊的成人原发性甲状腺毒症患者(TRAb<7.00 IU/L)158例。测定患者甲状腺功能、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、TRAb和131I摄取率。根据131I摄取率分为非降低组(正常范围或升高)98例和降低组60例。比较两组甲状腺激素、TRAb水平的差异; 按TRAb水平将患者分为5组,分析TRAb与131I摄取率的相关性; 采用受试者工作特征曲线分析TRAb判断131I摄取率非降低的有效性和实用价值。结果(1)158例甲状腺毒症患者中131I摄取率降低占38.0%。与131I摄取率降低组相比,131I摄取率非降低组促甲状腺激素、FT3、FT4、TRAb、TPOAb阳性率均升高(Z=5.159、4.451、3.078、7.417、3.920,P均<0.05)。(2)随着TRAb水平的升高,131I摄取率非降低患者的比例增多,131I摄取率降低患者的比例减少,各组之间总的差异有统计学意义(χ2=56.801,P=0.000)。TRAb≥0.20 IU/L组,131I摄取率非降低组的敏感性为98.0%,特异性为33.3%; TRAb≥1.75 IU/L组,131I摄取率非降低组的敏感性为67.3%,特异性为88.3%; TRAb≥3.50 IU/L组,131I摄取率非降低组的敏感性为35.7%,特异性为93.3%; TRAb≥5.25 IU/L组,131I摄取率非降低组的敏感性为19.4%,特异性为95.0%。(3)以Youden指数最大的切点为临界点,TRAb=1.56 IU/L为界值时,131I摄取率非降低组的敏感性为73.5%,特异性为86.7%。结论 无特异性临床表现、低滴度TRAb的原发性甲状腺毒症患者中,131I摄取率降低并非罕见。TRAb<3.50 IU/L,必须行131I摄取率鉴别甲状腺毒症病因。
Abstract:
Objective To study the correlation between thyrotropin receptor antibody(TRAb)titer and thyroid iodine uptake rate in patients with primary thyrotoxicosis and low titer TRAb. All patients had no specific clinical symptoms.Methods A total of 158 newly diagnosed patients with thyrotoxicosis whose TRAb were lower than 7.00 IU/L were included. Thyroid function, thyroid peroxidase antibody(TPOAb), thyroglobulin antibody(TgAb), TRAb, and iodine uptake rate were measured in all patients. According to the iodine uptake rate, they were divided into non-decreased group(at normal range or increased, n=98)and decreased group(n=60). The differences of thyroid hormone and TRAb between the two groups were compared. All patients were further divided into 5 groups according to their TRAb level to analyze the correlation between TRAb and iodine uptake rate. Receiver operating characteristic curves was used to analyze the validity and practicability of TRAb in diagnosing patients with non-decreased iodine uptake.Results(1)Among 158 patients with thyrotoxicosis, 38.0% patients had decreased thyroid iodine uptake rate. The level of thyroid stimulating hormone(TSH), free triiodothyronine(FT3), free thyroxine(FT4), TRAb, as well as the positive rate of TPOAb were higher in non-decreased group than those in decreased group(Z=5.159, 4.451, 3.078, 7.417, 3.920, all P<0.05).(2)With the increase of TRAb, the proportion of patients with non-decreased iodine uptake were increased and the proportion of patients with reduced iodine uptake were decreased, and the difference between groups was statistically significant(χ2=56.801, P=0.000). When using TRAb≥0.20 IU/L to diagnose non-decreased iodine uptake, the sensitivity was 98.0% and the specificity was 33.3%. When using TRAb≥1.75 IU/L, the sensitivity was 67.3% and the specificity was 88.3%. When using TRAb≥3.50 IU/L, the sensitivity was 35.7% and the specificity was 93.3%. When using TRAb≥5.25 IU/L, the sensitivity was 19.4% and the specificity was 95.0%.(3)Based on the maximum tangent point of Youden index, when using TRAb equal to 1.56 IU/L as the boundary value to diagnosing non-decreased iodine uptake rate, the sensitivity was 73.5% and the specificity was 86.7%.Conclusion Decreased iodine uptake is not uncommon in patients with low-titer TRAb thyrotoxicosis and without specific clinical symptoms. However, if TRAb is lower than 3.50 IU/L, the iodine uptake rate must be performed to identify the cause of thyrotoxicosis.

参考文献/References:

[1] Jameston JL. The thyroid gland//DeGroot LJ, eds. Endocrinology adult and pediatric[M].7th ed. London:W.B.Saunders Company,2013: 1516-1627.
[2] Davies TF, Laurberg P, Bahn RS. Hyperthyroid disorders//Melmed S, Polonsky KS, Larsen PR, et al, eds. Williams textbook of endocrinology[M].13th ed.Canada:Elsevier,Inc,2016:369-373.
[3] Gharib H,Enrico P,Jeffrey R,et al.American Association of Clinical Endocrinologists,American College of Endocrinolgy,and associazione medici endocrinologi medical guidelines for clinical paractice for the diagnosis and management and management of thyroid nodules—2016 update[J].Endocrine Practice, 2016, 22(Suppl 1):1-60.DOI:10.4158/EP161208.GL.
[4] Tozzoli R,Bagnasco M,Giavarina D,et al. TSH receptor autoantibody immunoassay in patients with Graves' disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis[J].Autoimmun Rev,2012,12(2):107-113. DOI:10.1016/j.autrev.2012.07.003.
[5] Costagliola S,Morgenthaler NG,Hoermann R,et al. Second generation assay for thyrotropin receptor antibodies has superior diagnostic sensitivity for Graves' disease[J].J Clin Endocrinol Metab,1999,84(1):90-97.DOI: 10.1210/jcem.84.1.5415.
[6] 向光大.临床甲状腺病学[M],第一版.北京:人民卫生出版社,2013:197.
[7] Bartalena L,Burch HB,Burman KD,et al. A 2013 European survey of clinical practice patterns in the management of Graves' disease[J].Clin Endocrinol(Oxf),2016,84(1):115-120.DOI:10.1111/cen.12688.
[8] Smith BR,Furmaniak J,Sanders J.TSH receptor blocking antibodies[J].Thyroid,2008,18(11):1239.DOI:10.1089/thy.2008.0278.
[9] Morshed SA,Davies TF.Graves' disease mechanisms:the role of stimulating, blocking, and cleavage region TSH receptor antibodies[J].Horm Metab Res,2015,47(10):727-734. DOI:10.1055/s-0035-1559633.
[10] Evans M,Sanders J,Tagami T,et al.Monoclonal autoantibodies to the TSH receptor, one with stimulating activity and one with blocking activity, obtained from the same blood sample[J].Clin Endocrinol(Oxf),2010,73(3):404-412. DOI:10.1111/j.1365-2265.2010.03831.x.
[11] Kahaly GJ,Diana T.TSH receptor antibody functionality and nomenclature[J].Front Endocrinol(Lausanne),2017,8:28.DOI:10.3389/fendo.2017.00028.

相似文献/References:

[1]胡晓娜,尹雅琪,谷伟军,等.TRAb水平与甲状腺相关性眼病活动度及严重程度的相关性分析[J].国际内分泌代谢杂志,2022,42(05):334.[doi:10.3760/cma.j.cn121383-20220306-03013]
　Hu Xiaona,Yin Yaqi,Gu Weijun,et al.Correlation between TRAb and thyroid-associated ophthalmopathy activity/severity scores[J].International Journal of Endocrinology and Metabolism,2022,42(03):334.[doi:10.3760/cma.j.cn121383-20220306-03013]

备注/Memo

备注/Memo:
通信作者:李冬梅,Email:ldm1229@126.com
Corresponding author: Li Dongmei, Email:ldm1229@126.com
更新日期/Last Update: 2020-05-20