对于血清抗甲状腺球蛋白抗体阳性的患者，超敏甲状腺球蛋白检测有作用吗？一项针对分化型甲状腺癌的大型（澳大利亚）队列研究。

Is there a role for an ultrasensitive thyroglobulin assay in patients with serum antithyroglobulin antibodies? A large (Australian) cohort study in differentiated thyroid cancer.

作者信息

McGrath Rachel T, Preda Veronica A, Clifton-Bligh Philip, Robinson Bruce, Sywak Mark, Delbridge Leigh, Ward Peter, Clifton-Bligh Roderick J, Learoyd Diana L

机构信息

Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia.

University of Sydney, Northern Clinical School, Sydney, NSW, Australia.

出版信息

Clin Endocrinol (Oxf). 2016 Feb;84(2):271-277. doi: 10.1111/cen.12736. Epub 2015 Feb 27.

DOI:10.1111/cen.12736

PMID:25656320

Abstract

OBJECTIVE

Serum thyroglobulin (Tg) is a marker of residual differentiated thyroid cancer (DTC) after total thyroidectomy; however, circulating antithyroglobulin antibodies (TgAb) may interfere with the immunoassay for Tg. Ultrasensitive assays may have a more significant role in detecting circulating Tg in the context of samples containing TgAb. The aim of this study was to evaluate the utility of ultrasensitive thyroglobulin (US-Tg) measurement compared to standard Tg measurement and to assess the influence of serum TgAb positivity on Tg detection in a large tertiary referral centre cohort in Australia.

DESIGN

All patients with DTC who had undergone total thyroidectomy were included in this retrospective, observational cohort study.

PATIENTS

Patients providing samples for the period of June 2006 until January 2014 were analysed. Three thousand two hundred and eight samples were measured at the same points in time, enabling serum Tg assays to be compared for the same TSH status (stimulated or suppressed).

MEASUREMENTS

The standard assay, the Siemens Immulite 2000 Tg assay, was compared to the serum ultrasensitive ELISA RSR Tg. TgAb were simultaneously measured using Abbott Architect or Immulite 2000.

RESULTS

There were 3019 samples included in the final analysis for comparison of the standard and ultrasensitive assays along with TgAb status. The majority of samples were TgAb negative (87%), with 48% of TgAb-negative samples associated with an undetectable serum Tg, suggestive of disease-free status at the time of sampling. Of note, 26% (n = 104) of the TgAb-positive samples were positive for Tg on the ultrasensitive Tg assay, but negative on the immulite Tg assay, and 62·5% (n = 65) of these samples corresponded to DTC recurrence.

CONCLUSION

The US-Tg assay has greater clinical utility than the standard immulite Tg assay specifically in the scenario of antibody positivity, with a significant number of samples corresponding to clinically relevant recurrent or metastatic disease.

摘要

目的

血清甲状腺球蛋白（Tg）是全甲状腺切除术后残留分化型甲状腺癌（DTC）的标志物；然而，循环抗甲状腺球蛋白抗体（TgAb）可能会干扰Tg的免疫测定。在含有TgAb的样本中，超敏测定法在检测循环Tg方面可能发挥更重要的作用。本研究的目的是评估超敏甲状腺球蛋白（US-Tg）测量相对于标准Tg测量的效用，并评估血清TgAb阳性对澳大利亚一家大型三级转诊中心队列中Tg检测的影响。

设计

本回顾性观察性队列研究纳入了所有接受全甲状腺切除术的DTC患者。

患者

分析了2006年6月至2014年1月期间提供样本的患者。在同一时间点测量了3208份样本，以便在相同的促甲状腺激素（TSH）状态（刺激或抑制）下比较血清Tg测定结果。

测量

将标准测定法（西门子Immulite 2000 Tg测定法）与血清超敏酶联免疫吸附测定（ELISA）RSR Tg进行比较。同时使用雅培Architect或Immulite 2000测定TgAb。

结果

最终分析纳入了3019份样本，用于比较标准和超敏测定法以及TgAb状态。大多数样本为TgAb阴性（87%），48%的TgAb阴性样本血清Tg检测不到，提示采样时处于无病状态。值得注意的是，26%（n = 104）的TgAb阳性样本在超敏Tg测定中呈Tg阳性，但在Immulite Tg测定中呈阴性，其中62.5%（n = 65）的样本对应于DTC复发。