TPOAb和TGAb滴度与Graves甲亢手术治疗后甲减的关系

Correlation Between the Serum Levels of TPOAb and TGAb and the Incidence of Hypothyroidism in Patients with Hyperthyroidism Caused by Graves Disease after Subtotal Thyroidectomy

目的测定手术治疗前Graves甲亢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,探讨TPOAb和TGAb滴度在手术治疗后与甲减发生的关系。方法 2010年1月—2012年5月在该科接受手术治疗的Graves病患者总计198人次,根据手术治疗前TPOAb、TGAb的检测结果,将198例患者分成3组:双阴组35例,单阳组38例,双阳组125例,比较各组间甲减的发生率;再将双阳组的125例患者,按TPOA b、TGA b滴度水平的高低分成3组:A组41例,B组54例,C组30例,进一步探讨手术治疗前TPOAb、TGAb滴度水平的高低与甲减的关系。结果双阳组甲减发生率明显高于双阴组、单阳组(P<0.05),单阳组甲减发生率明显高于双阴组(P<0.05)。双阳组的125例患者,按TPOAb、TGAb滴度水平高低分成3组,各组间甲减发生率差异有统计学意义(P<0.05)。结论 TGAb、TPOAb滴度水平的高低,对于甲亢手术治疗后甲减的预测有指导作用,观测以上指标可指导Graves病患者术中甲状腺腺体保留量,对减少术后甲减与复发有积极重要意义。

Objective To measure the serum levels of thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody antibody(TGAb) before surgery and investigate the correlation of them with the incidence of hypothyroidism after surgery in patients with hyperthyroidism caused by Graves disease. Methods A total of 198 cases with Graves disease underwent surgery in Department of Thyroid and Breast Surgery from January 2010 to May 2012 were divided into 3 groups, negative TPOAb and TGAb group(n =35),positive TPOAb or TGAb gruop(n = 38) and positive both TPOAb and TGAb group(n = 125) in accordance with the measurement result of TPOAb and TGAb. The incidence of hypothyroidism was compared among the 3 groups after therapy. Further, the 125 cases in positive both TPOAb and TGAb group were sub-divided into 3 groups by the level of TPOAb and TGAb, group A(n=41),group B(n = 54) and group C(n= 30), for investigating the relationship of the levels of TPOAb and TGAb with the incidence of hypothyroidism before surgery. Results The incidence of hypothyroidism was much higher in the positive both TPOAb and TGAb group than that in the negative TPOAb and TGAb group and the positive TPOAb or TGAb group(P<0.05). The incidence of hypothyroidism was much higher in the positive TPOAb or TGAb group than that in the negative TPOAb and TGAb group(P<0.05).The difference in the incidence of hypothyroidism between the 3 subgroups of the positive both TPOAb and TGAb group was statistically significant(P<0.05). Conclusion The serum levels of TPOAb and TGAb is instructive in predicting the incidence of hypothyroidism after hyperthyroidism surgery. The observation of the above indicators is of great significance in guiding the reservation volume of thyroid gland during the surgery and reducing the incidence and recurrence rate of hypothyroidism in patients with Graves disease.