血清抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体测定的临床诊断意义

Clinical Validity of Anti-thyroperoxidase Antibody and Anti-thyroglobulin Antibody

目的了解血清抗甲状腺球蛋白抗体(anti-TgAb)和抗甲状腺过氧化物酶抗体(anti-TPOAb)测定对甲状腺疾病的临床诊断意义。方法采用化学发光免疫分析(CLIA)法测定389例患有各种甲状腺疾病及其相关疾病(包括经病理证实的桥本甲状腺炎、Graves病、结节性或毒性结节性甲状腺肿、甲状腺滤泡上皮细胞良、恶性肿瘤;临床诊断的亚急性甲状腺炎、其他内分泌疾病和甲状腺功能正常的其他自身免疫性疾病)患者和45例健康对照者的anti-TgAb和anti-TPOAb水平,并计算其阳性率。结果不同疾病患者的血清anti-TgAb和anti-TPOAb水平及阳性率之间差异具有显著性(均P<0.001),其中桥本甲状腺炎患者的血清anti-TgAb和anti-TPOAb水平和阳性率最高(其中位数分别为373和6974U/ml,阳性率分别为84.3%和86.3%),Graves病次之(中位数分别为84和1369U/ml,阳性率分别为44.8%和72.4%),亚急性甲状腺炎和其他自身免疫性疾病患者两种抗体的水平显著高于健康对照者(P<0.01),血清anti-TPOAb水平显著高于anti-TgAb水平,二者之间呈直线相关(r=0.673,P<0.001)。结论血清anti-TgAb和anti-TPOAb水平测定对自身免疫性甲状腺疾病具有临床鉴别诊断意义。

Objective To evaluate the clinical validity of anti-thyroperoxidase antibodyanti-TPOAband anti-thyroglobulin antibodyanti-TgAb. Method Serum levels of anti-TPOAb and anti-TgAb were assayed using chemiluminescence immunoassay in 434 subjects including 51 patients with Hashimoto's thyroiditis 58 with Graves' disease 68 with nodular goiter 56 with thyroid adenoma and carcinoma 56 with subacute thyroiditis 65 with euthyroid non-thyroid endocrine disease 35 with euthyroid non-thyroid autoimmune diseases and 45 euthyroid controls. Results The highest level and most positive results of serum anti-TgAb and anti-TPOAb were observed in patients with Hashimoto's thyroiditis(median 373 and 6 974 U/ml positive rate 84.3% and 86.3% followed by patients with Graves' disease(median 84 and 1 369 U/ml positive rate 44.8% and 72.4%). Serum anti-TgAb and anti-TPOAb were also more common in patients with subacute thyroiditis and other autoimmune diseases than in the controls. Conclusion The assay of serum anti-TPOAb and anti-TgAb by chemiluminescence immunoassy are useful in the differential diagnosis of autoimmune thyroid disease.