Chen Xide, Zhang Yongze, Lin Luxi, Chen Yuxia, Shen Ximei, Huang Lingning, Zhao Fengying, Yan Sunjie
Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Department of Endocrinology, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China.
BMC Endocr Disord. 2025 Jan 21;25(1):14. doi: 10.1186/s12902-024-01823-x.
This study aimed to determine whether a relationship exist between pre-therapy 25-hydroxyvitamin D levels and the remission/negative conversion rates of thyrotropin receptor antibody (TRAB) during treatment in patients with newly diagnosed Graves' disease (GD).
171 patients were included from the Endocrinology Department of the First Affiliated Hospital of Fujian Medical University in March 2013 to April 2016. Ninety-five patients of them were diagnosed at our hospital but transferred to local hospitals for treatment. Seventy-six patients were followed and treated at our hospital with a median follow-up time of 11.03 (range 6-27) months. Patients were divided into 3 groups according to baseline 25-hydroxyvitamin D levels; <20 ng/mL (31,43.05%), 20-29 ng /mL (20,27.78%), and ≥ 30 ng/mL (20,29.17%). The TRAB remission rate and negative conversion rate was assessed among each group.
There was a higher TSH and lower TRAB titer in the 20-29 ng/mL group at initial diagnosis. Cox regression analysis suggested that 20-29 ng/mL group had significantly higher remission rates [RR; 95% CI: 7.505 (1.401-40.201), 8.975 (2.759-29.196),6.853(2.206-21.285), respectively] and negative conversion rates [RR; 95% CI: 7.835 (1.468-41.804),7.189(1.393-37.092), 8.122(1.621-40.688)] at the 6-, 12-, and 24-month follow-up, respectively . The level of 25-hydroxyvitamin D at the time of initial diagnosis was not associated with the re-normal of free Triiodothyronine(FT3), free thyroxineIndex(FT4) or TSH levels during the follow-up.
Newly diagnosed GD patients with appropriate baseline 25-hydroxyvitamin D levels (20-29 ng/mL) are beneficial for the reduction of TRAB during antithyroid therapy.
本研究旨在确定新诊断的格雷夫斯病（GD）患者治疗前25-羟基维生素D水平与促甲状腺素受体抗体（TRAB）治疗期间的缓解/转阴率之间是否存在关联。
选取2013年3月至2016年4月福建医科大学附属第一医院内分泌科收治的171例患者。其中95例在我院确诊后转至当地医院治疗。76例在我院接受随访和治疗，中位随访时间为11.03（6 - 27）个月。根据基线25-羟基维生素D水平将患者分为3组：<20 ng/mL（31例，43.05%）、20 - 29 ng/mL（20例，27.78%）和≥30 ng/mL（20例，29.17%）。评估每组的TRAB缓解率和转阴率。
初诊时，20 - 29 ng/mL组的促甲状腺激素（TSH）较高，TRAB滴度较低。Cox回归分析表明，在6个月、12个月和24个月随访时，20 - 29 ng/mL组的缓解率[风险比（RR）；95%置信区间（CI）：分别为7.505（1.401 - 40.201）、8.975（2.759 - 29.196）、6.853（2.206 - 21.285）]和转阴率[RR；95% CI：分别为7.835（1.468 - 41.804）、7.189（1.393 - 37.092）、8.122（1.621 - 40.688）]显著更高。初诊时的25-羟基维生素D水平与随访期间游离三碘甲状腺原氨酸（FT3）、游离甲状腺素指数（FT4）或TSH水平恢复正常无关。
新诊断的GD患者，基线25-羟基维生素D水平适当（20 - 29 ng/mL）有利于抗甲状腺治疗期间TRAB的降低。
