甲状腺自身抗体联合测定在Graves病与桥本甲状腺功能亢进症鉴别诊断中的意义

Significance of combining tests of thyroid autoantibodies in differential diagnosis between Graves′s disease and Hashimoto′s hyperthyroidism

目的 探讨和鉴别Graves病和桥本甲状腺功能亢进症 (甲亢 ) ,提高临床检出率。方法 对临床诊断为甲亢患者 ,进行甲状腺细针细胞学检查 ,其中Graves病 49例 ,男 2 0例 ,女 2 9例 ,平均年龄 41± 1 1岁 ,桥本甲亢 2 2例 ,男 5例 ,女 1 7例 ,平均年龄 39± 1 2岁 ;分别对其进行甲状腺自身抗体 ,甲状腺过氧化物酶抗体 (TPOAb) ,甲状腺微粒体抗体 (TMA) ,甲状腺球蛋白抗体 (TGA) ,促甲状腺素受体抗体 (TRAb)、游离三碘甲状腺原氨酸 (FT3)、游离四碘甲状腺原氨酸 (FT4)联合测定 ,分析这些抗体在Graves病组 ,桥本甲亢组中的变化及与甲状腺功能 ,以及与甲状腺大小的关系。结果 Graves病组TRAb、FT3水平明显高于桥本甲亢组 ,差异有显著意义 ,其TRAb、TPOAb、TMA、TGA的阳性率分别为 83 67%、75 51 %、57 1 4 %、48 98% ,TPOAb与TGA的双项阳性率为 48 98%。桥本甲亢组TRAb阳性率为 1 3 64 % ,其余阳性率均为 86 36 % ,TPOAb与TGA的双项阳性率为86 36 % ,明显高于Graves病组。相关性分析显示 ,TRAb与FT3呈显著正相关 ,双侧甲状腺弥漫性、对称性增大与FT3、TRAb正相关。结论 对TRAb、TPOAb、TGA、FT3进行综合判断分析 。

Objective To investigate the differential diagnosis between Graves′s disease and Hashimoto′s hyperthyroidism to improve positive diagnostic rate in Hashimoto′s hyperthyroidism,to facilitate proper management Methods Cytological examination was conducted by fine needle biopsy ( FNB) on the thyroids of patients with hyperthyroidism diagnosed by clinical data, including 22 cases of Hashimoto′s hyperthyroidism, 5 males and 17 females, aged 39±12, and 49 cases of Graves′s disease, 20 males and 29 females, aged 41±11 Thyroid auto antibodies--thyroid peroxidase antibody (TPOAb), thyroid microsomal antibody (TMA), thyroglobulin antibody (TGA), thyroid stimulating hormone receptor antibody (TRAb), and free serum triiodothyronine (FT3), free thyroxin (FT4), and serum thyroid stimulating hormone (S TSH) were tested The correlation between the pathology of thyroid and different autoantibodies and thyroid hormone was analyzed Results TRAb was 42 28±75 89 in Graves disease group, significantly higher than that in Hashimoto′s hyperthyroidism group (5 77±12 69, P <0 001) FT3 was 16 13±9 95, significantly higher than that in Hashimoto′s hyperthyroidism group (9 54±6 76, P <0 01) In Graves′s disease group the positive rates for TRAb, TPOAb, TMA, and TGA were 83 67%, 75 51%, 57 14% and 48 98% respectively In Hashimoto′s hyperthyroidism group, the positive rate for TRAb was 13 64%, and the positive rates for the rest autoantibodies were all 86 36% The double positive rate of TPOAb and TGA was 86 36% in Hashimoto′s hyperthyroidism group, significantly higher than that in Graves′s disease group (48 98%) There was a positive association between TRAb and FT3, and between diffuse and symmetric increased size of thyroid and FT3 TRAb Conclusion Comprehensive analysis of TRAb, TPOAb, TGA, and FT3 is helpful to the differential diagnosis between Graves′s disease and Hashimoto′s hyperthyroidism