Turner综合征患儿的甲状腺自身抗体的初步观察

Thyroid autoantibodies in children with Turner′s syndrome

目的 观察Turner综合征(TS)患儿甲状腺自身抗体 (TAA)的阳性率及其对患儿甲状腺功能的影响。方法 采用放射免疫方法及化学发光法对 24例经临床检查和染色体分析确诊的TS患儿血抗甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化酶抗体(TPOAb)及甲状腺功能进行检测。超过正常值(TgAb<30%、TPOAb<20% )者为TAA阳性。对TAA阳性和TAA阴性患儿的年龄、骨龄及甲状腺功能等进行了分析。结果 24例TS患儿中有 7例(29% )为TAA阳性, 17例为阴性。两组患儿年龄、骨龄差异均无统计学意义。TAA阳性者中 3例为亚临床甲状腺功能低下, 2例为甲状腺功能低下,而TAA阴性患儿只有 4例表现为亚临床甲状腺功能低下,两组差异有统计学意义(P<0.05)。结论 TS患儿的TAA阳性率约为 29%,TAA阳性的TS患儿甲状腺功能异常的例数远多于TAA阴性的TS患儿。

Objective Turner′s syndrome (TS) is characterized by the absence of an X chromosome or th e presence of a structurally abnormal X chromosome in a phenotypic female. It was recently reported that autoimmune thyroiditis (AIT) was found in 38% of wh ite patients with TS, and few studies in this aspect have been conducted in Chin a. The purpose of this study was to determine the frequency of AIT among TS pat ients and risk factors for development of thyroid dysfunction in Chinese childre n with TS. Methods Serum antithyroglobulin antibody (TgAb), thyroperoxidase antibody (TPOAb) and th yroid function (T 3, T 4 and TSH) of 24 children with TS (mean age 12.9±2. 4 yeras, range 4.8-16.8 years)were assessed. Their karyotype distribution was as follows: thirteen patients with 45,XO kayrotype, eight patients with str ucturally abnormal X chromosome, two with X mosaic kayrotype and one with 46,XX . Techniques including radioimmunoassy and elctro-chemiluminescence immunoassy were used in this study. All TS children were divided into two groups. Group one was thyroid autoantibodies (TAA)-positive group, the levels of TgAb and /or TPOAb in them were higher than the normal levels (TgAb < 30%, TPOAb <20%), resp ectively, and the remaining patients were assigned into TAA-negative group.Results Seven of the 24 (29 %) patients had higher levels of TgAb and TPOAb than the normal values (<30% and <20%). The level of serum TSH[6.1(3.6-100 .0) mU/L]in TAA-positive group was significantly higher than that[3.9(1. 7-7.9) mU/L]in TAA-negative group (P<0.05). The frequency of hypothyr oidism or subclinical hypothyroidism in TAA-positive group (5/7) was higher tha n that in TAA-negative group (3/17) (P<0.05). Conclusion The positive rate of serum TAA in children with TS was 29 %. About 7 0% TS children with positive serum TAA developed hypothyroidism or subclinical h ypothyroidism. The results have provided the basis for regular follow-up asses sment of thyroid autoantibodies and thyroid function in children with TS, and th ese measures are of importance for timely diagnosis of thyroid dysfunction and a pplication of appropriate treatment.