血清甲状腺激素与多发性硬化症患者发病、临床分型以及疾病严重程度相关性研究

The Correlation Between Serum Thyroid Hormone Levels and theIncidence and Severity of Multiple Sclerosis

目的 探讨正常范围内血清甲状腺激素水平与多发性硬化症(MS)患者发病、临床分型及疾病严重程度的相关性。方法 纳入首都医科大学附属北京天坛医院自2015年1月至2023年4月明确诊断为MS患者共121例,收集其相关临床资料,根据患者的临床诊断分型分为复发缓解型(RRMS)91例,继发进展型(SPMS)30例。同时收集同期来院体检的与MS组年龄、性别相匹配的121例健康对照(HCs)人群的临床资料。比较各组受试者之间的血清甲状腺激素水平,并分析其与MS疾病的发病、临床分型及严重程度的相关性。结果 MS组患者血清TT3及FT4水平明显低于HCs组,差异有统计学意义(P<0.05)。RRMS组患者血清FT_(3)水平明显高于SPMS组,差异有统计学意义(P<0.05)。相关性分析显示,MS患者血清FT_(3)水平与EDSS评分成负相关(r=-0.22,P=0.02)。ROC曲线分析发现,在诊断MS时,血清TT3的ROC曲线下面积(AUC)为0.722,最佳界值为1.465nmol/L,灵敏度69.5%,特异性33.1%;血清FT4的AUC为0.692,最佳界值为11.615pmol/L,灵敏度72.7%,特异性41.3%。如果将两个指标组合进行联合诊断,AUC为0.764,灵敏度78.1%,特异性32.2%。血清FT_(3)在鉴别诊断RRMS和SPMS中具有显著的意义。AUC为0.713,最佳界值为4.19pmol/L,灵敏度86.6%,特异性53.3%。结论 血清TT3与FT4对MS的诊断具有重要的价值,而血清FT_(3)则对MS的疾病分型有鉴别诊断作用,且其与MS疾病的严重程度成负相关。

Objective To investigate the correlation between serum thyroid hormone levels within normal range and the morbidity,clinical classification and disease severity in patients with multiple sclerosis(MS).Methods A total of 121 patients diagnosed with MS from January,2015 to April,2023 were enrolled for the study from Beijing Tiantan Hospital Affiliated to Capital Medical University.Clinical data of all patients were collected.According to the clinical diagnosis,91 patients were classified as relapse-remitting type(RRMS),while 30 patients were secondary progressive type(SPMS).In addition,clinical data of 121 healthy control(HCs)patients who visited our hospital for physical examination during the same period and matched with the age and sex of MS group were collected.Serum thyroid hormone levels among all groups were compared,and the correlation with the onset,clinical classification and severity of MS disease was analyzed.Results Serum TT 3 and FT 4 levels in MS group were significantly lower than those in the healthy control group(P<0.05).Serum FT_(3) level in RRMS group was significantly higher than that in SPMS group(P<0.05).Correlation analysis showed that serum FT_(3) level was negatively correlated with EDSS score in MS patients(r=-0.22,P=0.02).ROC curve analysis showed that the area under ROC curve(AUC)of serum FT 4 was 0.692.The optimal threshold was identified as 11.615 pmol/L,with the sensitivity of 72.7%,and the specificity of 41.3%for diagnosing MS.The AUC of serum TT 3 was 0.722.With the cut-off value 1.465 nmol/L,the sensitivity was 69.5%,and the specificity was 33.1%.If the two indexes were combined for combined diagnosis,the AUC was 0.764,with the sensitivity of 78.1%and the specificity of 32.2%.Serum FT_(3) showed significant power in the differential diagnosis of RRMS and SPMS,having the sensitivity and specificity of 86.6%and 53.3%,respectively,with an AUC of 0.713 and an optimal cut-off of 4.19pmol/L.Conclusion Serum TT 3 and FT 4 are of great value in the diagnosis of MS,while serum FT_(3) has a promising role in the differential diagnosis of MS disease types,and it is negatively correlated with the severity of MS disease.