FT_(3)/TSH比值在甲状腺毒症患者病因诊断中价值的初探

The Value of FT_(3)/TSH Ratio in Etiological Diagnosis of Newly Diagnosed Patients with Subacute Thyrotoxicosis

目的研究FT_(3)/TSH比值在Graves病与亚急性甲状腺炎鉴别诊断方面的应用价值。方法回顾性研究2020年3月至2020年5月因甲状腺功能异常而就诊于我院内分泌科门诊的患者,共239例,所有患者均为首次发现甲状腺功能异常且未进行任何相关治疗,包括108例亚急性甲状腺炎患者,131例Graves病患者。通过ROC曲线来评价FT_(3)、FT_(4)、TSH、FT_(3)/FT_(4)比值、FT_(3)/TSH比值在鉴别诊断Graves病与亚急性甲状腺炎的cut-off值、灵敏度、特异性、阳性预测值、阴性预测值以及诊断准确度,寻找最佳诊断参数。结果FT_(3)/TSH比值鉴别诊断Graves病和亚急性甲状腺炎的ROC曲线下面积为0.851,高于FT_(3)、FT_(4)、TSH以及FT_(3)/FT_(4)比值的ROC曲线下面积,cut-off值为1108.571pg/μLU时,灵敏度为75.57%,特异性为87.04%,阳性预测值为86.84%,阴性预测值为74.40%,诊断准确度为80.33%。结论FT_(3)/TSH比值可以作为鉴别诊断Graves病与亚急性甲状腺炎参考指标之一,且优于FT_(3)、FT_(4)、TSH和FT_(3)/FT_(4)比值。

Objective To study the value of FT_(3)/TSH ratio in differential diagnosis of Graves′disease and subacute thyroiditis.Methods A total of 239 patients with thyroid dysfunction who were admitted to the Endocrinology Clinic of our hospital from January,2020 to May,2020 were retrospectively studied.All patients were found to have thyroid dysfunction for the first time without any related treatment,including 108 patients with subacute thyroiditis and 131 patients with Graves′disease.ROC curve was drawn to identify the best cut-off value,and to evaluate sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of FT_(3),FT_(4),TSH,FT_(3)/FT_(4) ratio and FT_(3)/TSH ratio in the differential diagnosis of Graves′disease and subacute thyroiditis,and the AUROC was compared to find the best diagnostic parameters.Results AUROC of FT_(3)/TSH ratio for differential diagnosis of Graves′disease and subacute thyroiditis was 0.851,which was higher than that of FT_(3),FT_(4),TSH and FT_(3)/FT_(4) ratio.When the cut-off value was 1108.571pg/μLU,the sensitivity was 75.57%and specificity was 87.04%;The positive predictive value was 86.84%,while the negative predictive value was 74.40%,and the diagnostic accuracy was 80.33%.Conclusion FT_(3)/TSH ratio can be used as a reference for the differential diagnosis of Graves′disease and subacute thyroiditis,and is better than FT_(3),FT_(4),TSH and FT_(3)/FT_(4) ratio.