住院老年慢性患者的甲状腺自身抗体：患病率、年龄影响、非甲状腺临床状态及甲状腺功能

Thyroid autoantibodies in hospitalized chronic geriatric patients: prevalence, effects of age, nonthyroidal clinical state, and thyroid function.

作者信息

Szabolcs I, Bernard W, Horster F A

机构信息

1st Department of Medicine, Haynal Imre University of Health Sciences, Budapest, Hungary.

出版信息

J Am Geriatr Soc. 1995 Jun;43(6):670-3. doi: 10.1111/j.1532-5415.1995.tb07204.x.

DOI:10.1111/j.1532-5415.1995.tb07204.x

PMID:7775728

Abstract

OBJECTIVE

To investigate the effect of age, clinical condition, and thyroid function on the prevalence of thyroid autoantibody positivity in hospitalized chronic geriatric patients.

DESIGN

A screening study of hospitalized chronic geriatric patients.

PARTICIPANTS

249 non-selected, hospitalized, chronic geriatric patients more than 60 years of age and 81 20 to 40-year-old healthy persons.

MEASUREMENTS

Thyrotropin (TSH); thyroxine (T4) and free thyroxine (FT4); and triiodothyronine (T3), thyroglobulin (Tg), antibodies against thyroid peroxidase (AbTPO) and antibodies against thyroglobulin (AbTg) estimation in a screening study.

RESULTS

AbTPO positivity (AbTPO+) was found more often than AbTg positivity (AbTg+) (15.3% vs 9.2%, P = .04), one being positive (Ab+) in 19.3%. The occurrence was higher in females than males (Ab+:27.1% vs 7.1%, P < .001; AbTPO+:21.9% vs 5.1%, P < .001; AbTg+:13.2% vs 3.1%, P = .0052). Among the Ab+ patients, AbTPO was more often positive than AbTg (40/48 vs 21/48, P < .001). The sensitivity, specificity, and positive predictive value of Ab positivity to detect a thyroid disorder were 0.35, 0.85 and 0.38, respectively. Within the population of euthyroid geriatric patients, the occurrence of AbTg+ (chi 2(2) = 8.65, P = .013) and Ab+ (chi 2(2) = 8.02, P = .018) correlated positively with the age of the patients, and there was also a female predominance (AbTPO+ 18% vs 3.7% in the males; AbTg+ 13% vs 2.4%; Ab+ 25.8% vs 6.1%). When compared with 20 to 40-year-old subjects, only the euthyroid > or = 80-year-old patients showed a significantly higher occurrence of Ab+ (26.2% vs 9.9% chi 2(1) = 5.64, P = .017). In the euthyroid > or = 80-year-old females, AbTPO+ was 25%, AbTg:22.2%, and Ab+: 36.1%!. The nonthyroidal clinical state of the euthyroid patients did not correlate with the antibody prevalence.

CONCLUSIONS

In hospitalized chronic geriatric patients, AbTg and especially AbTPO positivity is frequent, even in euthyroid patients without goiter. This aspecific Ab positivity in the euthyroid state correlates to the age, but not to the severity of the nonthyroidal clinical condition of the patients and explains why the Ab positivity is not predictive enough for thyroid dysfunction in this subpopulation. Thus, in hospitalized chronic geriatric patients the AbTg and AbTPO titers should be examined only in cases where thyroid screening (TSH) reveals abnormal results.

摘要

目的

研究年龄、临床状况和甲状腺功能对住院老年慢性病患者甲状腺自身抗体阳性率的影响。

设计

对住院老年慢性病患者进行的筛查研究。

研究对象

249例未经过挑选的60岁以上住院老年慢性病患者以及81例20至40岁的健康人。

测量指标

在一项筛查研究中检测促甲状腺激素（TSH）、甲状腺素（T4）和游离甲状腺素（FT4）、三碘甲状腺原氨酸（T3）、甲状腺球蛋白（Tg）、抗甲状腺过氧化物酶抗体（AbTPO）和抗甲状腺球蛋白抗体（AbTg）。

结果

发现AbTPO阳性（AbTPO+）的情况比AbTg阳性（AbTg+）更常见（15.3%对9.2%，P = 0.04），两者之一为阳性（Ab+）的比例为19.3%。女性的发生率高于男性（Ab+：27.1%对7.1%，P < 0.001；AbTPO+：21.9%对5.1%，P < 0.001；AbTg+：13.2%对3.1%，P = 0.0052）。在Ab+患者中，AbTPO阳性比AbTg更常见（40/48对21/48，P < 0.001）。Ab阳性检测甲状腺疾病的敏感性、特异性和阳性预测值分别为0.35、0.85和0.38。在甲状腺功能正常的老年患者群体中，AbTg+（χ²(2)=8.65，P = 0.013）和Ab+（χ²(2)=8.02，P = 0.018）的发生率与患者年龄呈正相关，且也以女性居多（AbTPO+：男性为3.7%，女性为18%；AbTg+：男性为2.4%，女性为13%；Ab+：男性为6.1%，女性为25.8%）。与20至40岁的受试者相比，只有甲状腺功能正常且年龄≥80岁的患者Ab+发生率显著更高（26.2%对9.9%，χ²(1)=5.64，P = 0.017）。在甲状腺功能正常且年龄≥80岁的女性中，AbTPO+为25%，AbTg为22.2%，Ab+为36.1%！甲状腺功能正常患者的非甲状腺临床状态与抗体患病率无关。

结论

在住院老年慢性病患者中，即使是无甲状腺肿的甲状腺功能正常患者，AbTg尤其是AbTPO阳性也很常见。甲状腺功能正常状态下这种非特异性的Ab阳性与年龄相关，但与患者非甲状腺临床状况的严重程度无关，这解释了为什么Ab阳性对该亚组人群的甲状腺功能障碍预测性不足。因此，在住院老年慢性病患者中，只有在甲状腺筛查（TSH）结果异常的情况下才应检测AbTg和AbTPO滴度。