Hu Y L, Li X, Fang H S, Ye X H, Shen M P, Wu X H
Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
Zhonghua Yi Xue Za Zhi. 2021 Aug 24;101(32):2537-2543. doi: 10.3760/cma.j.cn112137-20201120-03154.
To compare the diagnostic performance of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and high-resolution ultrasound (HRUS) in euthyroid Hashimoto's thyroiditis (HT). From January 2016 to January 2019, patients with complete data of preoperative thyroid function, TPOAb, TgAb and HRUS who had undergone thyroid surgery treatment at the First Affiliated Hospital with Nanjing Medical University were reviewed. The diagnostic value of different diagnostic methods was compared using histopathology (HP) examination result as the gold standard. The data of 792 patients (217 males and 575 females) was retrospectively collected. The (,)of patients' age was 41(32,52)years and the range was 16-75 years. With HP as the diagnostic gold standard, TPOAb exhibited similar sensitivity (59.3% vs 61.2%, =0.752), accuracy (85.0% vs 83.6%, =0.379), area under the receiver operating characteristic curve (AUC) (0.767 vs 0.764, =0.886) and higher specificity (94.2% vs 91.6%, =0.033) when compared with TgAb in diagnosing euthyroid HT. They both exhibited a higher sensitivity (59.3% vs 44.5%, = 0.002; 61.2% vs 44.5%, 0.001), accuracy (85.0% vs 79.7%, = 0.001; 83.6% vs 79.7%, = 0.013) and AUC (0.767 vs 0.684, 0.001; 0.764 vs 0.684, 0.001) than HRUS. Compared with each method alone, the sensitivity and AUC of TPOAb combined with TgAb or HRUS were improved. The combination of three methods showed the greatest sensitivity. Concordance analysis demonstrated that TPOAb and HP had a moderate agreement (Kappa=0.580, 95%:0.513-0.647,<0.001). The combination of thyroid antibodies, TPOAb and TgAb, can improve sensitivity, accuracy and AUC of diagnosis in euthyroid Hashimoto's thyroiditis. The two antibodies combined with HRUS exhibited the highest diagnostic performance. Elevated TPOAb showed moderate diagnostic consistency with histopathologic evidence of HT.
比较甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）和高分辨率超声（HRUS）对亚临床型桥本甲状腺炎（HT）的诊断效能。回顾性分析2016年1月至2019年1月在南京医科大学第一附属医院接受甲状腺手术治疗、术前甲状腺功能、TPOAb、TgAb及HRUS资料完整的患者。以组织病理学（HP）检查结果为金标准，比较不同诊断方法的诊断价值。回顾性收集792例患者（男217例，女575例）资料，患者年龄为41（32，52）岁，范围16～75岁。以HP为诊断金标准，在诊断亚临床型HT时，TPOAb与TgAb相比，敏感性相似（59.3%对61.2%，P = 0.752）、准确性相似（85.0%对83.6%，P = 0.379）、受试者工作特征曲线下面积（AUC）相似（0.767对0.764，P = 0.886），而特异性更高（94.2%对91.6%，P = 0.033）。二者与HRUS相比，均表现出更高的敏感性（59.3%对44.5%，P = 0.002；61.2%对44.5%，P = 0.001）、准确性（85.0%对79.7%，P = 0.001；83.6%对79.7%，P = 0.013）和AUC（0.767对0.684，P = 0.001；0.764对0.684，P = 0.001）。与单独使用每种方法相比，TPOAb联合TgAb或HRUS的敏感性和AUC均有所提高。三种方法联合使用时敏感性最高。一致性分析显示，TPOAb与HP有中度一致性（Kappa = 0.580，95%CI：0.513 - 0.647，P<0.001）。甲状腺抗体TPOAb和TgAb联合应用可提高亚临床型桥本甲状腺炎诊断的敏感性、准确性和AUC。两种抗体联合HRUS诊断效能最高。TPOAb升高与HT的组织病理学证据有中度诊断一致性。
