促甲状腺激素受体抗体在诊断毒性弥漫性甲状腺肿病中的应用价值

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摘要目的探讨毒性弥漫性甲状腺肿（Graves）病诊断中促甲状腺激素受体抗体（TRAb）的应用价值。方法回顾性选取2019年10月—2020年10月阳江市阳东区人民医院收治的760 例甲状腺疾病患者，依据临床症状体征、病史及辅助检查结果将其分为初诊Graves 病组（n=300）、原发性甲状腺功能减退组（原发性甲减组，n=200）、甲状腺结节组（n=150）、甲状腺功能亢进期亚急性甲状腺炎组（甲亢期亚甲炎组，n=110）四组，另回顾性选取同期50 例健康体检人员作为健康对照组。统计分析初诊Graves 病组和健康对照组的血清TRAb、抗甲状腺过氧化物酶抗体（ATpo）、甲状腺球蛋白抗体（TGAb）水平及阳性情况，并统计分析五组的血清TRAb 水平及阳性情况，采用ROC曲线评价TRAb 在Graves 病诊断中的应用价值。结果初诊Graves 病组的血清TRAb、ATpo、TGAb 水平及阳性率均高于健康对照组，差异有统计学意义（P＜0.05）。初诊Graves 病组的血清TRAb 水平高于原发性甲减组、甲状腺结节组、甲亢期亚甲炎组，差异有统计学意义（P＜0.05）；初诊Graves 病组的TRAb 阳性率高于原发性甲减组、甲状腺结节组、甲亢期亚甲炎组，差异有统计学意义（P＜0.05）。TRAb 的ROC 曲线下面积为0.973，诊断临界值为22.5 IU/mL，敏感度、特异度分别为96.0%、91.1%，正确率、阳性预测值、阴性预测值分别为92.6%、82.8%、98.1%。结论 Graves 病诊断中TRAb 的应用价值高。

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关键词 ：毒性弥漫性甲状腺肿病, 原发性甲状腺功能减退, 甲状腺结节, 甲状腺功能亢进期亚急性甲状腺炎, 促甲状腺激素受体抗体, ROC 曲线

Abstract：Objective To investigate the application value of thyroid stimulating hormone receptor antibody (TRAb) in the diagnosis of Graves disease.Methods A total of 760 cases of patients with thyroid diseases in People′s Hospital of Yangdong District in Yangjiang City from October 2019 to October 2020 were selected retrospectively.According to the clinical symptoms and signs, medical history and auxiliary examination results, they were divided into four groups:newly diagnosed Graves disease group (n=300), primary hypothyroidism group (n=200), thyroid nodule group (n=150)and hyperthyroidism subacute thyroiditis group (n=110).In addition, 50 cases of healthy people in the same period were selected as healthy control group.The serum levels of TRAb, anti-thyroid peroxidase antibody (ATpo), thyroglobulin antibody (TGAb) and the positive situations of the newly diagnosed Graves disease group and the healthy control group were statistically analyzed.The serum levels of TRAb and the positive situation of the five groups were statistically analyzed.The ROC curve was used to evaluate the application value of TRAb in the diagnosis of Graves disease.Results The serum levels of TRAb, ATpo and TGAb and their positive rates in the newly diagnosed Graves disease group were higher than those in the healthy control group, the differences were statistically significant (P＜0.05).The serum TRAb level of the newly diagnosed Graves disease group was higher than that of the primary hypothyroidism group, thyroid nodule group and hyperthyroidism subacute thyroiditis group, the differences were statistically significant (P＜0.05).The TRAb positive rate of the newly diagnosed Graves disease group was higher than that of the primary hypothyroidism group, thyroid nodule group and hyperthyroidism subacute thyroiditis group, the differences were statistically significant(P＜0.05).The area under the ROC curve of TRAb was 0.973, the critical v alue of diagnosis was 22.5 IU/mL,the sensitivity and specificity were 96.0% and 91.1% respectively, the correct rate, positive predictive value and negative predictive value were 92.6%, 82.8% and 98.1% respectively.Conclusion The application value of TRAb is high in the diagnosis of Graves disease.

Key words： Graves disease Primary hypothyroidism Thyroid nodules Subacute thyroiditis in hyperthyroidism Thyroid stimulating hormone receptor antibody ROC curve

收稿日期: 2020-12-25

基金资助:广东省阳江市医疗卫生类科技计划项目（SF202 0203）

引用本文:

谢晓婷；梁健夫；莫超云. 促甲状腺激素受体抗体在诊断毒性弥漫性甲状腺肿病中的应用价值[J]. 中国当代医药, 2021, 28(20): 187-189转193.
XIE Xiao-ting LIANG Jian-fu MO Chao-yun. Application value of thyroid stimulating hormone receptor antibody in the diagnosis of Graves disease. 中国当代医药, 2021, 28(20): 187-189转193.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I20/187

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