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格林-巴利综合征与慢性炎症性脱髓鞘性多发性神经根神经病发展过程中甲状腺功能及自身抗体的差异

Differences in Thyroid Function and Autoantibodies in the Development of Guillain-Barré Syndrome vs. Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

作者信息

Tu Yu, Gong Xuan, Zeng Guanwen, Zhuo Wenyan, Li Zhaoxia, Yu Xueying

机构信息

Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China.

Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

Front Neurol. 2020 Sep 10;11:1018. doi: 10.3389/fneur.2020.01018. eCollection 2020.

Abstract

Both Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are neurodegenerative and inflammatory demyelination disorders. Sporadic reports showed that the increased levels of thyroid function and autoantibodies are associated with GBS, CIDP, or both, but no systematic study has been reported. We assessed the differences of thyroid function and autoantibodies between GBS and CIDP in a Chinese cohort. A total of 256 patients were enrolled in this study. 175 clinically confirmed GBS and CIDP patients were selected. Meanwhile, 81 patients hospitalized for diseases other than GBS or CIDP with mild symptoms were enrolled as a control group. Relevant clinical data, including thyroid function, and autoantibody examinations, were collected for statistical analysis. In the comparison of thyroid function and autoantibody parameters, the levels of total thyroxine (TT4), thyroid peroxidase antibody (TPO-Ab), and thyroglobulin antibody (TG-Ab) in the GBS group were all higher than those in the CIDP and Control groups ( < 0.01). The thyroid antibody positive rates in the GBS and CIDP groups were 70.10 and 14.10%, respectively ( < 0.01). In the receiver operating characteristic (ROC) curve analysis, TT4, TPO-Ab, and TG-Ab were higher in the GBS group and lower in the CIDP group ( < 0.01). To achieve a high specificity of 97-99%, the diagnostic cutoff value of TPO-Ab was higher than 133 IU/mL (Sensitivity: 11.34%) or lower than 0.01 IU/mL (Sensitivity: 9.09%), while the diagnostic cutoff value of TG-Ab was higher than 261.1 IU/mL (Sensitivity: 2.06%) or lower than 0.46 IU/mL (Sensitivity: 11.69%). Multivariate logistic regression analysis showed that the differences in TPO-Ab were statistically significant between GBS patients with TPO-Ab was higher than 133 IU/mL and CIDP patients ( < 0.01); the differences in TG-Ab were statistically significant between GBS patients with TG-Ab was higher than 261.1 IU/mL and CIDP patients ( < 0.05). The elevation of thyroid autoantibodies was associated with GBS. TPO-Ab higher than 133 IU/mL or lower than 0.01 IU/mL and TG-Ab higher than 261.1 IU/mL or lower than 0.46 IU/mL had high specificity for differentiating between GBS and CIDP; therefore, TPO-Ab and TG-Ab can be used as biomarkers for the differential diagnosis of GBS and CIDP.

摘要

吉兰-巴雷综合征(GBS)和慢性炎症性脱髓鞘性多发性神经根神经病(CIDP)均为神经退行性和炎症性脱髓鞘疾病。零星报道显示,甲状腺功能和自身抗体水平升高与GBS、CIDP或两者均有关联,但尚无系统性研究报告。我们在中国队列中评估了GBS和CIDP患者甲状腺功能及自身抗体的差异。本研究共纳入256例患者。选取175例临床确诊的GBS和CIDP患者。同时,纳入81例因GBS或CIDP以外疾病住院且症状较轻的患者作为对照组。收集相关临床资料,包括甲状腺功能及自身抗体检测结果,进行统计分析。在甲状腺功能和自身抗体参数比较中,GBS组总甲状腺素(TT4)、甲状腺过氧化物酶抗体(TPO-Ab)和甲状腺球蛋白抗体(TG-Ab)水平均高于CIDP组和对照组(<0.01)。GBS组和CIDP组甲状腺抗体阳性率分别为70.10%和14.10%(<0.01)。在受试者工作特征(ROC)曲线分析中,GBS组TT4、TPO-Ab和TG-Ab水平较高,CIDP组较低(<0.01)。为达到97 - 99%的高特异性,TPO-Ab诊断临界值高于133 IU/mL(灵敏度:11.34%)或低于0.01 IU/mL(灵敏度:9.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6642/7511860/5295ff6d2a31/fneur-11-01018-g0001.jpg

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