甲状腺功能诊断的新策略——TSH免疫放射法

TSH(IRMA)-Anew strategy for the diagnosis of thyroid function

报道了应用两位点TSH免疫放射法(TSH-IRMA)与T_3、T_4、FT_3、FT_4同时检测452例病例。在非甲状腺疾病患者TSH含量为1.69±0.95μIU/ml,甲亢TSH水平被抑制为<0.3μIU/ml,甲亢治疗缓解者85％TSH含量恢复正常,但迟于T_3、T_4、FT_3、FT_4。甲减TSH含量升高>5μIU/ml。TRH兴奋试验的基础TSH含量与高峰时TSH含量有良好相关性(γ=0.88),在诊断甲亢时基础TSH值可替代TRH兴奋试验。用TSH(IRMA)与TSH(RIA)两法检测比较,IRMA法灵敏度高最小检测量为<0.03μIU/ml,它是甲亢与甲减两者兼容的检测方法。对TBG异常的妊娠、肝硬化、尿毒症等非甲状腺疾患(NTI)测定甲状腺功能时TSH(IRMA)优于T_3、T_4、FT_3、FT_4,可作为甲状腺功能诊断的首选试验。也是甲亢甲减药物治疗中“精细调节”的指标,表示从生理生化角度达到甲状腺功能正常。

The serum TSH of 452 patients were measured with a two-site immunoradio-metric assay (IRMA). The serum TSH level was 1.69±0.95μIU/ml in euthyroid subjects, and was much lower in patients with hyperthyroidism (i. e. 0.3μIU/ml) which returned to nearly normal in 85% patients who were in remission stage. On the contrary, serum TSH level elavated to more than 5μIU/ml in patients with hypothyroidism. TRH stimulation test showed that the baseline serum TSH values correlated well with the peak serum TSH value post-TRH (r=0.88). TSH (IRMA) improved the sensitivity over that of conventional radioimmunoassays, hence has made possible discrimination between hyperthyroid, euthyroid and hypothyroid subjects, and may serve as a first-line test in the diagnosis of thyroid dysfunction. In addition, when serum thyroid hormone levels have been brought to normal range, a further 'fine adjustment' of treatment based on serum TSH levels appears to be helpful to achieve physiologically and biochemically.