TPOAb、TgAb检测在桥本氏甲状腺炎中的意义

Significance of TPOAb and TgAb detection in Hashimoto′s thyroiditis

目的通过比较不同时期桥本氏甲状腺炎(HT)患者血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)的水平和阳性率,为临床上HT的治疗提供参考依据。方法选择2019-2020年在西苑医院就诊的HT患者,按临床表现及实验室结果将其分为桥本甲亢组和桥本甲减组,对两组患者分别取血分离血清后检测促甲状腺激素(TSH)、TgAb和TPOAb,并对两种抗体水平及阳性率进行组间比较。随后,采用Logistic回归和ROC曲线分析评估TgAb和TPOAb的诊断效能。结果TSH和TgAb水平在桥本甲亢组和桥本甲减组间差异均有统计学意义(P<0.01);TgAb阳性率在桥本甲亢组为50.0%,明显低于桥本甲减组的96.7%,差异有统计学意义(P<0.01);而TgAb和TPOAb双阳性率在桥本甲亢组和桥本甲减组中分别为43.3%、70.0%,差异有统计学意义(P<0.05)。TgAb水平小于1个正常参考值上限(<1个ULN)时,桥本甲亢组例数(15例)明显多于桥本甲减组(1例),差异有统计学意义(P<0.01);TgAb水平大于5个ULN时,桥本甲亢组的例数(4例)明显小于桥本甲减组(14例),组间差异有统计学意义(P<0.01);其余组间差异均无统计学意义(P>0.05)。ROC曲线分析显示,TgAb单项检测及TgAb、TPOAb联合检测的AUC分别是0.733(95%CI:0.603~0.864)和0.600(95%CI:0.456~0.744),两者差异有统计学意义(P<0.01)。结论在HT甲亢和甲减时期患者血清TSH和TgAb水平、TgAb阳性率、TgAb和TPOAb双阳性率均有差异,为进一步研究甲状腺自身抗体在HT疾病发展中的作用奠定基础。

Objective To compare the levels and positive rates of thyroid peroxidase antibody(TPOAb)and thyroglobulin antibody(TgAb)in the patients with different stages of Hashimoto′s thyroiditis(HT)so as to provide a reference basis for the clinical treatment of HT.Methods The HT patients treated in Xiyuan Hospital from 2019 to 2020 were selected and divided into the Hashimoto hyperthyroidism group and Hashimoto hypothyroidism group according to the clinical manifestations and laboratory results.Thyroid stimulating hormone(TSH),TgAb and TPOAb were detected after the blood sample collection and separation,and the levels and positive rates of the two antibodies were compared between the two groups.Then,the Logistic regression and receiver operating characteristic(ROC)curve analysis were used to evaluate the diagnostic efficiency of TgAb and TPOAb.Results The TSH and TgAb levels had statistically significant difference between the Hashimoto hyperthyroidism group and Hashimoto hypothyroidism group,the positive rate of TgAb in the Hashimoto hyperthyroidism group was 50.0%,which was significantly lower than 96.7%in the Hashimoto hypothyroidism group,and the difference was statistically significant(P<0.05).The double positive rates of TgAb and TPOAb in the Hashimoto hyperthyroidism group and Hashimoto hypothyroidism group were 43.3%and 70.0%respectively,and the difference was statistically significant(P<0.05).When the TgAb level was less than the upper limit of a normal reference value(<1 ULN),the number of cases(15 cases)in the Hashimoto hyperthyroidism group was significantly more than that in Hashimoto hypothyroidism group(1 case),and when the TgAb level was>5 ULN,the number of cases(4 cases)in the Hashimoto hyperthyroidism group was significantly lower than that in Hashimoto hypothyroidism group(14 cases),and the difference between groups was statistically significant(P<0.01).There was no statistically significant difference among the other groups(P>0.05).The ROC curve analysis showed that the area under the curve(AUC)of single TgAb detection and combined detection of TgAb and TPOAb were 0.733(95%CI:0.603-0.864)and 0.600(95%CI:0.456-0.744),respectively.Conclusion There are differences in the levels of serum TSH and TgAb,positive rates of TgAb,and double positive rates of TgAb and TPOAb in the patients with HT hyperthyroidism and hypothyroidism,which lays a foundation for further study of the role of thyroid autoantibodies in the development of HT disease.