甲状腺切除后患者血清TSH和TGAb及TPOAb水平变化及其临床意义

Changes and clinical significance of serum TSH,TGAb,and TPOAb levels in patients after thyroidectomy

目的检测甲状腺切除后患者血清促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TGAb)、甲状腺微粒体抗体(TPOAb)表达水平的变化,探讨患者术后发生甲状腺功能减退(简称甲减)的影响因素。方法选取2017年5月-2021年5月期间在宿州市第一人民医院住院的100例甲状腺疾病患者为研究对象。根据术后复查情况,将患者分为甲减组(n=34)与非甲减组(n=66),比较甲减与非甲减患者间血清TSH、TGAb、TPOAb水平。使用多因素Logistic回归分析患者术后发生甲减的影响因素;受试者工作特征(ROC)曲线分析血清TSH、TGAb、TPOAb水平对患者术后发生甲减的诊断价值。结果患者进行甲状腺切除术前TSH[(3.98±1.32)μIU/mL vs.(8.42±2.17)μIU/mL]、TGAb[(176.65±38.15)U/mL vs.(89.64±21.43)U/mL]、TPOAb[(189.57±45.86)IU/mL vs.(97.88±26.45)IU/mL]水平与术后比较,差异有统计学意义(P<0.05)。与非甲减组比较,甲减组患者TSH[(8.42±2.17)μIU/mL vs.(1.97±0.74)μIU/mL]、TGAb[(89.64±21.43)U/mL vs.(38.76±7.84)U/mL]、TPOAb[(97.88±26.45)IU/mL vs.(34.92±6.16)IU/mL]水平显著升高(P均<0.05)。Logistic回归分析显示,手术方式、TSH、TGAb、TPOAb是患者术后发生甲减的危险因素(P<0.05)。ROC曲线分析结果显示,TSH、TGAb、TPOAb联合诊断术后甲减发生的曲线下面积(AUC)为0.832,可提高特异性,但敏感度有所降低。结论甲状腺切除后患者血清TSH、TGAb、TPOAb水平变化与患者术后是否发生甲减有显著的相关性,对是否发生甲减有一定的诊断价值。

Objective To detect the changes in serum thyroid stimulating hormone(TSH),anti-thyroglobulin antibody(TGAb),and thyroid microsomal antibody(TPOAb)expression levels in patients after thyroidectomy,and explore the influencing factors of hypothyroidism in patients after surgery.Methods A total of 100 patients with thyroid disease who were hospitalized in our hospital from May 2017 to May 2021 were selected as the research objects.According to the postoperative review,the patients were divided into hypothyroidism group and non-hypothyroidism group,and the serum TSH,TGAb,TPOAb levels were compared between hypothyroidism and non-hypothyroidism;the influencing factors of postoperative hypothyroidism were analyzed with multivariate logistic regression;the diagnostic value of serum TSH,TGAb,and TPOAb levels in patients with postoperative hypothyroidism was analyzed with receiver operator characteristic(ROC)curve.Results The levels of TSH(3.98±1.32)μIU/m L vs.(8.42±2.17)μIU/m L,TGAb(176.65±38.15)U/m L vs.(89.64±21.43)U/m L and TPOAb(189.57±45.86)IU/m L vs.(97.88±26.45)IU/m L in patients undergoing thyroidectomy were significantly different between before and after surgery(P<0.05).Compared with the non-hypothyroidism group,the TSH(8.42±2.17)μIU/m L vs.(1.97±0.74)μIU/m L,TGAb(89.64±21.43)U/m L vs.(38.76±7.84)U/m L and TPOAb(97.88±26.45)IU/m L vs.(34.92±6.16)IU/m L of patients in the hypothyroidism group were significantly higher(P<0.05).Logistic regression analysis showed that surgical methods,TSH,TGAb,and TPOAb were risk factors for postoperative hypothyroidism(P<0.05),The ROC curve analysis results showed that the area under the curve(AUC)for the combined diagnosis of postoperative hypothyroidism by TSH,TGAb,and TPOAb was 0.832,which could improve the specificity,but the sensitivity decreased.Conclusion The changes in serum TSH,TGAb and TPOAb levels of patients after thyroidectomy were significantly correlated with hypothyroidism after surgery,and had certain diagnostic value for the occurance of hypothyroidism.