血清TPOAb、TMAb及TRAb水平对甲状腺功能亢进患者131I治疗后甲状腺功能减退风险的预测价值

The predictive value of serum TPOAb, TMAb, and TRAb levels for the risk of hypothyroidism in patients with hyperthyroidism after 131 I treatment

目的分析血清甲状腺过氧化物酶抗体(TPOAb)、甲状腺微粒体抗体(TMAb)及促甲状腺素受体抗体(TRAb)水平对Graves病(GD)患者经131I治疗后出现甲状腺功能减退(甲减)风险的预测价值。方法选取2019年1月—2020年12月于新疆医科大学第一附属医院甲状腺外科收治的Graves病患者209例纳入研究,全部患者均规律接受131治疗。随访1年失联9例,根据是否发生甲减将患者分为甲减组59例、非甲减组141例,比较2组患者甲状腺功能指标及放射治疗相关指标,采用多因素Logistic回归模型分析影响患者预后的因素,采用受试者工作特征曲线(ROC)分析影响患者预后指标的预测价值。结果甲减组患者治疗前停药时间、TPOAb、TMAb水平及131I剂量显著高于非甲减组,TRAb显著低于非甲减组(t/P=3.275/0.001、6.013/<0.001、7.532/<0.001、6.662/<0.001、4.455/<0.001);多因素Logistic回归分析示,TPOAb高、TMAb高及131I剂量高是Graves病患者出现甲减的独立危险因素[OR(95%CI)=1.005(1.003~1.008)、1.205(1.101~1.320)、21.005(3.440~128.262)],而TRAb高水平则是患者出现甲减的独立保护因素[OR(95%CI)=0.821(0.753~0.895)];TPOAb、TRAb、TMAb、131I剂量及四者联合预测Graves病患者131I治疗后发生甲减的曲线下面积(AUC)分别为0.770、0.846、0.748、0.784、0.949,四者联合预测患者预后的诊断效能高于各自单独预测(Z=4.639、3.959、5.491、4.563,P均<0.001)。结论TPOAb、TRAb及TMAb联合能有效对Graves病患者131I治疗后甲减进行预测,具有较高的诊断价值及诊断效能。

Objective To analyze the predictive value of serum Thyroid peroxidase antibody(TPOAb),thyroid microsomal antibody(TMAb)and thyroid stimulating hormone receptor antibody(TRAb)levels on the risk of hypothyroidism(hypothyroidism)in patients with Graves’disease(GD)after 131 I treatment.Methods Two hundred and nine Graves'disease patients in the Thyroid Surgery Department of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to December 2020 were selected for the study.Following up for one year,9 cases of loss of contact were divided into hypothyroidism group of 59 cases and non-hypothyroidism group of 141 cases based on the occurrence of hypothyroidism.Thyroid function indicators and radiation therapy related indicators were compared between the two groups.Multivariate logistic regression models were used to analyze the factors affecting patient prognosis,and the predictive value of patient performance characteristic curves(ROCs)was used to analyze the prognostic indicators.Results The pretreatment withdrawal time,TPOAb,TMAb levels,and 131 I dose of patients in the hypothyroidism group were significantly higher than those in the non-hypothyroidism group,while TRAb was significantly lower than those in the non-hypothyroidism group(t/P=3.275/0.001,6.013/<0.001,7.532/<0.001,6.662/<0.001,4.455/<0.001);Multivariate logistic regression analysis showed that high levels of TPOAb,TMAb,and 131 I dosage were independent risk factors for hypothyroidism in Graves’disease patients[OR(95%CI)=1.005(1.003-1.008),1.205(1.101-1.320),21.005(3.440-128.262)],while high levels of TRAb were independent protective factors for hypothyroidism in patients[OR(95%CI)=0.821(0.753-0.895)];The area under the curve(AUC)of TPOAb,TRAb,TMAb,131 I doses,and their combination in predicting hypothyroidism in Graves'disease patients after 131 I treatment were 0.770,0.846,0.748,0.784,and 0.949,respectively.The diagnostic efficacy of the combination of the four in predicting patient prognosis was higher than that of their individual predictions(Z=4.639,3.959,5.491,4.563,P<0.001).Conclusion The combination of TPOAb,TRAb,and TMAb can effectively predict hypothyroidism in Graves'disease patients after 131 I treatment,and has high diagnostic value and efficacy.