TRH兴奋试验峰值与基础sTSH比值诊断亚临床甲亢

The peak and basic sTSH Ratio of TRH stimulating Test for the Diagnosis of subclinical hyperthy-roidism

目的分析TRH兴奋试验峰值与基础sTSH比值在诊断亚临床甲亢中的价值。方法实验分3组,利用TRH兴奋试验在甲状腺功能正常、亚临床甲亢和正常对照组中,于TRH兴奋试验前后分别静脉采血3ml,同批测定0、15、30、60及120min的sTSH含量,求出其峰时与0时的sTSH比值(P/B),了解其诊断符合率。结果静脉注射TRH后30min时,其sTSH值达高峰;兴奋试验前、后其sTSH含量显示有性别差异;基础sTSH值各组男、女诊断符合率分别为94.7%、95.2%,88.3%、86.1%,98.2%、98.8%;而各组男、女的P/B值分别是9.0,11.2;6.3,5.3;9.0,13.5。诊断符合率达100%。亚临床甲亢与甲状腺功能正常组,亚临床甲亢与正常对照组,甲状腺功能正常与正常对照组间其差异性分别是P<0.01、P<0.01、P>0.05。亚临床甲亢与正常对照组的sTSH的升高值有显著性差异,P<0.01;甲状腺功能正常与对照组间无显著性差异,P>0.05;如用峰时与0时的sTSH比值(P/B)来判断,男性<9.1倍,女性<13.5倍,则揭示垂体-甲状腺轴功能失常。结论基础sTSH在诊断亚临床甲亢中的灵敏度仍有限,欲准确了解垂体-甲状腺轴的功能,明确亚临床甲亢的诊断,作TRH兴奋试验,求出峰时与基础sTSH比值更具重要的临床意义。

Objective To analyze the value of peak and basic TSH ratio of TRH stimulating test for the diagnosis of subclinical hyperthyroidism.Methods In groups of euthyroid patients,subclini-cal hyperthyroidism and normal control,the sTSH were determined before and after stimulation test of TRH in order to compare diagnostic accuracy of test.Results The content of sTSH showed sexual difference,before and after TRH stimulating test coincidence rate of male and female being97.7%and95.2%,88.3%and86.1%,98.2%and98.8%,respectively in each group,the difference between groups being P<0.01,P<0.01,P>0.05.thirty min-utes after intravenous injection of TRH,singificant difference was shown in the value of peak of sTSH between the group of hyperthyroidism and controlgroup,P<0.01;but no significant difference be-tween the group of normal thyroid function and control group.If the peak value compared with the basic value of sTSH in male was<9.1times and in female<13.5,it indicated that the relation of hy-pophysis-thyroid was abnormal.Conclusions The sensitivity of sTSH in the diagnosis of subclinical hyperthyroidism is still limited.In order to under-stand the more exact relationship between hypop hysis and thyroid,the stimulating test of TRH is greater clinical significance than determination of sTSH alone.