[甲状腺自身抗体联合检测在Graves病与桥本甲状腺炎伴甲亢鉴别诊断中的意义]

[Significance of combining tests of thyroid autoantibodies in differential diagnosis between Graves's disease and Hashimoto's hyperthyroidism].

作者信息

Hu Yu-mei, Liu Wei, Lu Guang-hua

机构信息

Department of Internal Medicine, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2003 Jun 10;83(11):940-2.

PMID:12899792

Abstract

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.

摘要

目的

探讨格雷夫斯病与桥本甲状腺炎伴甲亢的鉴别诊断，以提高桥本甲状腺炎伴甲亢的诊断阳性率，促进合理治疗。

方法

对经临床资料确诊为甲亢的患者甲状腺进行细针穿刺活检（FNB）细胞学检查，其中桥本甲状腺炎伴甲亢22例，男5例，女17例，年龄39±12岁；格雷夫斯病49例，男20例，女29例，年龄41±11岁。检测甲状腺自身抗体——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）、促甲状腺激素受体抗体（TRAb），以及血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和血清促甲状腺激素（S-TSH）。分析甲状腺病理与不同自身抗体及甲状腺激素之间的相关性。

结果

格雷夫斯病组TRAb为42.28±75.89，显著高于桥本甲状腺炎伴甲亢组（5.77±12.69，P<0.001）。FT3为16.13±9.95，显著高于桥本甲状腺炎伴甲亢组（9.54±6.76，P<0.01）。格雷夫斯病组TRAb、TPOAb、TMA和TGA的阳性率分别为83.67%、75.51%、57.14%和48.98%。桥本甲状腺炎伴甲亢组TRAb阳性率为13.64%，其余自身抗体阳性率均为86.36%。桥本甲状腺炎伴甲亢组TPOAb和TGA双阳性率为86.36%，显著高于格雷夫斯病组（48.98%）。TRAb与FT3之间，以及甲状腺弥漫性对称性肿大与FT3、TRAb之间呈正相关。