促甲状腺素抗体/促甲状腺素受体抗体比值作为活动性 Graves 眼病的敏感筛查试验。

Thyroid-Stimulating Antibody/Thyroid-Stimulating Hormone Receptor Antibody Ratio as a Sensitive Screening Test for Active Graves' Orbitopathy.

机构信息

Department of Clinical Laboratory Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan.

出版信息

Endocr Pract. 2022 Oct;28(10):1050-1054. doi: 10.1016/j.eprac.2022.07.007. Epub 2022 Jul 21.

DOI:10.1016/j.eprac.2022.07.007

PMID:35870804

Abstract

OBJECTIVE

Graves' orbitopathy (GO), an extrathyroidal manifestation of Graves' disease, can seriously threaten a patient's quality of life. Given that immunosuppressive treatment during the early active phase of GO has been found to reduce both disease activity and severity, sensitive screening tests are needed.

METHODS

The present study included 86 patients with GO, in whom serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine, thyroid-stimulating antibody, TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin, and thyroglobulin antibody were measured within 2 months before magnetic resonance imaging (MRI) for orbit assessment.

RESULTS

The thyroid-stimulating antibody/TSH receptor antibody ratio was able to distinguish MRI results with a correct classification rate of 81%. When focusing on patients without T3 predominant Graves' diseases, the ratio distinguished MRI results at a rate of 92%. Receiver operating characteristic curve analysis revealed a cutoff antibody ratio of 87, which yielded a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 91%, 95%, 18.2, and 0.0957, respectively, for distinguished MRI results.

CONCLUSIONS

The thyroid-stimulating antibody/TSH receptor antibody ratio is a highly sensitive and specific indicator for active GO, especially in patients without T3 predominance, and serves as a good screening test for active GO in primary care settings.

摘要

目的

Graves 眼病（GO）是 Graves 病的一种甲状腺外表现，可严重威胁患者的生活质量。鉴于 GO 早期活动期的免疫抑制治疗已被证实可降低疾病活动度和严重程度，因此需要敏感的筛查试验。

方法

本研究纳入了 86 例 GO 患者，在进行眼眶磁共振成像（MRI）评估前 2 个月内测量了血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（T3）、游离甲状腺素、促甲状腺素抗体、促甲状腺素受体抗体、甲状腺过氧化物酶抗体、甲状腺球蛋白和甲状腺球蛋白抗体的水平。

结果

促甲状腺刺激抗体/促甲状腺素受体抗体比值能够区分 MRI 结果，正确分类率为 81%。当关注无 T3 优势 Graves 病患者时，该比值的区分 MRI 结果的准确率为 92%。受试者工作特征曲线分析显示，截断抗体比值为 87，其区分 MRI 结果的灵敏度、特异性、阳性似然比和阴性似然比分别为 91%、95%、18.2 和 0.0957。