甲状腺过氧化物酶抗体诊断老年自身免疫性甲状腺炎的临床价值

Clinical value of thyroid peroxidase antibody in the diagnosis of autoimmune thyroiditis in elderly patients

目的探讨甲状腺过氧化物酶抗体(TPOAb)对老年自身免疫性甲状腺炎的诊断价值。方法476例老年甲状腺手术患者,根据手术后常规病理切片中主要甲状腺结节性病灶周围组织表现分为桥本氏甲状腺炎(HT)组(53例)、非HT性淋巴细胞性甲状腺炎组(8例)及未合并自身免疫性甲状腺炎组(415例)。所有受试者均于手术前空腹抽取静脉血,离心分离出血清,检测血清样本中的游离三碘甲腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)及TPOAb。比较三组的FT_(3)、FT_(4)、TSH及TPOAb水平,并分析TPOAb诊断自身免疫性甲状腺炎的敏感性、特异性、阳性预测价值、阴性预测价值、诊断准确率。结果476患者手术后病理证实甲状腺恶性肿瘤108例,甲状腺良性疾病368例。HT组和非HT性淋巴细胞性甲状腺炎组患者TPOAb水平分别为(218.03±136.04)、(74.39±43.13)IU/ml,均显著高于未合并自身免疫性甲状腺炎组的(22.27±13.07)IU/ml,且HT组显著高于非HT性淋巴细胞性甲状腺炎组,差异具有统计学意义(P<0.05)。三组患者血清FT3、FT4水平比较差异无统计学意义(P>0.05);HT组TSH水平(3.24±1.63)mIU/L显著高于未合并自身免疫性甲状腺炎组的(2.57±1.50)mIU/L,差异具有统计学意义(P<0.05)。TPOAb诊断自身免疫性甲状腺炎的敏感性为81.97%(20/61),特异性为86.27%(358/415),阳性预测价值为46.73%(50/107),阴性预测价值为97.02%(358/369),诊断准确率为85.71%(408/476)。结论血清TPOAb检测可有效应用于老年甲状腺患者中自身免疫性甲状腺炎的诊断。

Objective To discuss the value of thyroid peroxidase antibody in the diagnosis of autoimmune thyroiditis in elderly patients.Methods A total of 476 elderly patients undergoing thyroid surgery were divided into Hashimoto’s thyroiditis(HT)group(53 cases),non-HT lymphocytic thyroiditis group(8 cases)and non-autoimmune thyroiditis group(415 cases)according to pathological features of the surrounding tissues of the main thyroid nodules.Before operation,venous blood was collected from all subjects on an empty stomach,and the serum samples were centrifuged to detect free triiodothyronine(FT_(3)),free thyroxine(FT_(3)),thyroid stimulating hormone(TSH)and TPOAb.The levels of FT_(3),FT_(4),TSH and TPOAb were compared among the three groups,and the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of TPOAb in the diagnosis of autoimmune thyroiditis were analyzed.Results There were 108 cases of malignant thyroid tumors and 368 cases of benign thyroid diseases confirmed pathologically after surgery in 476 patients.The TPOAb levels of HT group and non-HT lymphocytic thyroiditis group were(218.03±136.04)and(74.39±43.13)IU/ml,which were significantly higher than(22.27±13.07)IU/ml of non-autoimmune thyroiditis group,and the HT group was significantly higher than non-HT lymphocytic thyroiditis group.All the difference was statistically significant(P<0.05).There was no statistically significant difference in serum FT3 and FT4 among the three groups(P>0.05).The TSH levels(3.24±1.63)mIU/L of HT group was significantly higher than(2.57±1.50)mIU/L of nonautoimmune thyroiditis group,and the difference was statistically significant(P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of TPOAb in the diagnosis of autoimmune thyroiditis were 81.97%(20/61),86.27%(358/415),46.73%(50/107),97.02%(358/369)and 85.71%(408/476).Conclusion Serum TPOAb is effective in the diagnosis of autoimmune thyroiditis in elderly patients.