甲状腺过氧化物酶抗体和甲状腺球蛋白抗体阳性临界值的确定及其临床意义

目的 确定甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）的阳性临界值，并探讨这两种抗体出现的临床意义。方法 1999至2000年对3个中国农村社区3761名进行甲状腺疾病流行病学调查，采血、尿标本，同时行甲状腺B超检查，2004年对该人群进行随访。所有血清标本均用固相化学发光酶免疫分析法测定TPOAb和TgAb及促甲状腺激素（TSH）水平。结果 甲状腺功能及形态正常人群（2437名）TPOAb和TgAb的95％正常可信区间上限分别为37．8IU／ml和38．6IU／ml。总人群（3761名）中随TPOAb浓度的升高发生TSH升高（〉4．8IU／m1）或降低（〈0．3IU／m1）的比率也呈阶梯式增加，但仅当TPOAb≥50IU／ml时，发生TSH异常率比TPOAb438IU／ml者的差异有统计学意义（P〈0．01）。同样TgAb≥40IU／ml时，发生TSH异常率比TgAb≤39IU／ml者差异也有统计学意义（P〈0．01）。当TPOAb以50IU／ml和TgAb以40IU／ml为阳性临界值时，总人群中TPOAb和TgAb的阳性率女性（11．71％、11．21％）显著高于男性（4．07％、2．68％）。抗体阳性人群的TSH水平显著高于抗体阴性组（P〈0．05）。原TSH正常抗体阳性人群（515名）随访发现甲状腺功能减退症的发生率显著高于抗体阴性人群（P〈0．05）。结论 用高灵敏性化学发光酶免疫分析法在尿碘中位数为100～600μg/L的普通人群中确定TPOAb和强Ab的阳性临界值分别为50IU／ml和40IU／ml。甲状腺自身抗体TPOAb和TgAb阳性是发生甲状腺功能损伤的重要危险因素。     

Effect of iodine intake on serum thyroglobulin——A five-year prospective epidemiological study

Objective To clarify the effect of iodine intake on serum thyroglobulin (Tg). Methods A 5-year prospective study was conducted in the 3 different iodine intake areas in China [Panshan (miht deficiency) ,Zhangwu (more than adequate) and Huanghua (excess)]. A total of 3 099 people with normal serum levels of Tg in 1999 were followed and 2 448 of these participants were feasible to be observed in 2004 and included in the present study. The serum levels of Tg, thyraglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and TSH, thyroid volume, family and personal histories of thyroid diseases were measured and inquried. The general linear model (GLM) was used to explore the determinants of Tg. Results Among the study population at baseline, serum Tg were significantly different in three areas [7.5 (4.4-13. 1) μg/L at Panshan, 6.8 (3.6-11.2)μg/L at Huanghua, 5.9 (3.2-10.7) μg/L at Zhangwu, P<0.01]. They were associated with age, sex and the rate of positive TgAb, abnormal thyroid volume, abnormal TSH and positive personal history of thyroid diseases, in order to control the effects of confounding factors, the data from 1856 subjects with thyroid-related indexes all in normal range and without personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. The serum Tg among three areas were significantly different in both 1999 and 2004, they were all increased in 5 years with significant augment (△ Tg) among the three areas[3.1 (-0.2-8.0) μg/L at Panshan, 3.5 (0.5-9.0)μg/L at Huanghua vs 2. 5(0.3-6.1) μg/L at Zhangwu,P<0.01]. The GLM analysis revealed that age, Tg and TSH levels at baseline were the determinants of △Tg in addition to iodine intake. Conclusion Iodine intake is a dominant determinant of serum Tg. Age and TSH should also be considered while indicating iodine intake by serum Tg.     

单纯性甲状腺肿

单纯性甲状腺肿，是指非炎症和非肿瘤原因阻碍甲状腺激素合成而导致的甲状腺代偿性肿大。一般甲状腺功能正常，不伴有功能亢进或减退，甲状腺为弥漫性或多结节性肿大。可呈地方性分布，当人群单纯性甲状腺肿的患病率超过10％时，称为地方性甲状腺肿，常为缺碘所致。也可散发分布，称为散发性甲状腺肿，患病率约5％，女性患病率是男性的3～5倍。病因复杂，多数病人则找不出明确的病因，有些患者的甲状腺肿是由于合成甲状腺激素的某个步骤的酶缺乏，或致甲状腺肿物质等所致。在我国，生理代偿性和结节性是最常见的甲状腺肿的类型。     

碘摄入量不同地区人群甲状腺自身抗体的流行病学研究

为了研究不同碘摄入量人群的甲状腺自身抗体的变化以及甲状腺自身抗体阳性人群甲状腺功能的变化 ,我们在三个不同碘摄入量的农村社区盘山、彰武和黄骅进行甲状腺疾病入户问卷调查共 16 2 87人 (≥ 14岁 ) ,对其中的 376 1人进行体格检查并采血、尿标本及甲状腺B超检查。检测全部尿样的尿碘含量 ;所有血清标本均应用固相化学发光酶免疫分析方法测定甲状腺过氧化物酶抗体 (TPOAb )和甲状腺球蛋白抗体 (TGAb )及血清第三代TSH水平。结果显示盘山、彰武和黄骅社区的尿碘中位数分别为 10 3 15 μg/L、 374 76 μg/L和 6 14 6 1μg/L (P <0 0 1)。我们发现盘山、彰武和黄骅社区TPOAb和TGAb阳性率均无显著差异 (P >0 0 5 )。在TPOAb阳性的人群中 ,黄骅和彰武社区出现临床或亚临床甲状腺功能减退的比率明显高于盘山社区 (P <0 0 1)。虽然三社区TPOAb和TGAb阳性率无显著差异 ,但是高碘社区存在甲状腺自身免疫异常者发生甲状腺功能减退的危险性显著增加 ,特别是甲状腺自身抗体呈高水平的患者     

Effect of iodine intake on serum thyroglobulin——A five-year prospective epidemiological study

Objective To clarify the effect of iodine intake on serum thyroglobulin (Tg). Methods A 5-year prospective study was conducted in the 3 different iodine intake areas in China [Panshan (miht deficiency) ,Zhangwu (more than adequate) and Huanghua (excess)]. A total of 3 099 people with normal serum levels of Tg in 1999 were followed and 2 448 of these participants were feasible to be observed in 2004 and included in the present study. The serum levels of Tg, thyraglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and TSH, thyroid volume, family and personal histories of thyroid diseases were measured and inquried. The general linear model (GLM) was used to explore the determinants of Tg. Results Among the study population at baseline, serum Tg were significantly different in three areas [7.5 (4.4-13. 1) μg/L at Panshan, 6.8 (3.6-11.2)μg/L at Huanghua, 5.9 (3.2-10.7) μg/L at Zhangwu, P<0.01]. They were associated with age, sex and the rate of positive TgAb, abnormal thyroid volume, abnormal TSH and positive personal history of thyroid diseases, in order to control the effects of confounding factors, the data from 1856 subjects with thyroid-related indexes all in normal range and without personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. The serum Tg among three areas were significantly different in both 1999 and 2004, they were all increased in 5 years with significant augment (△ Tg) among the three areas[3.1 (-0.2-8.0) μg/L at Panshan, 3.5 (0.5-9.0)μg/L at Huanghua vs 2. 5(0.3-6.1) μg/L at Zhangwu,P<0.01]. The GLM analysis revealed that age, Tg and TSH levels at baseline were the determinants of △Tg in addition to iodine intake. Conclusion Iodine intake is a dominant determinant of serum Tg. Age and TSH should also be considered while indicating iodine intake by serum Tg.     

甲状腺超声广泛低回声临床意义的探讨

目的　探讨甲状腺超声广泛低回声 (以下称广泛低回声 )在自身免疫性甲状腺病 (AITD)诊断上的临床意义。方法　对 3个农村地区 3 5 46名 14岁以上居民进行甲状腺超声、甲状腺功能、甲状腺自身抗体 (TAA)检查。结果　广泛低回声表现为散在性和弥漫性。自身免疫性甲状腺炎 (AITT)组 ( 64例 )散在和弥漫性低回声检出率分别为 2 1.9%和 46.9% ,Graves病 (GD)组 ( 4 2例 )为 5 4.8%和 19.0 % ,均高于非毒性甲状腺肿组 ( 4 94例 )和正常对照组 ( 2 40 1例 ) (P <0 .0 1) ,后两者 79.6%和 99.3 %为正常回声。TAA阳性组低回声检出率明显高于阴性组 (P <0 .0 1)。弥漫性低回声检出率随甲状腺过氧化物酶抗体、TSH受体抗体 (TRAb)和甲状腺球蛋白抗体水平升高而增加 ,散在性低回声检出率随TRAb水平升高而增加。结论　广泛低回声多见于AITD ,与甲状腺自身免疫明显相关。GD多为散在性低回声 ,AITT多为弥漫性低回声。     

碘摄入量对血清甲状腺球蛋白的影响——5年流行病学随访研究

目的 观察碘摄入量对血清甲状腺球蛋白(Tg)水平的影响.方法 对1999年盘山(轻度碘缺乏地区)、彰武(碘超足量地区)和黄骅(碘过量地区)血清Tg水平正常的3 099人进行随访,将2004年随访到的2 448人作为研究人群.测定Tg、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)、促甲状腺素(TSH)、甲状腺容积,并询问甲状腺疾病的家族史和个人史.分析Tg的影响因素.结果 1999年初访时,不同碘摄入地区Tg水平差异显著[盘山7.5(4.4～13.1)μg/L、黄骅6.8(3.6～11.2)μg/L彰武5.9(3.2～10.7)μg/L,P<0.01];年龄、性别、TgAb阳性、甲状腺肿大、TSH异< 凹鬃聪偌膊「鋈耸范訲g水平的影响亦显著.为排除混杂因素的影响,对TgAb、甲状腺容积、TSH、甲状腺疾病个人史均无异常的1 856人的随访数据进行分析,其初访及随访的Tg水平均有显著地区差异,轻度碘缺乏以及碘过量地区都显著高于碘超足量地区.三地区随访时Tg水平均显著升高,且增加值(△Tg)存在显著地区差异[盘山3.1(-0.2～8.0)μg/L、黄骅3.5(0.5～9.0)μg/L/35彰武2.5(0.3～6.1)μg/L,P<0.01];碘摄入量、初访时的Tg水平、TSH水平及年龄为ATg的独立影响因素.结论 碘摄入量显著影响血清Tg水平,当用血清Tg水平来估计地区碘摄入水平及其变化时,应该同时考虑年龄及TSH等因素.     

Effect of iodine intake on serum thyroglobulin——A five-year prospective epidemiological study

Objective To clarify the effect of iodine intake on serum thyroglobulin (Tg). Methods A 5-year prospective study was conducted in the 3 different iodine intake areas in China [Panshan (miht deficiency) ,Zhangwu (more than adequate) and Huanghua (excess)]. A total of 3 099 people with normal serum levels of Tg in 1999 were followed and 2 448 of these participants were feasible to be observed in 2004 and included in the present study. The serum levels of Tg, thyraglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and TSH, thyroid volume, family and personal histories of thyroid diseases were measured and inquried. The general linear model (GLM) was used to explore the determinants of Tg. Results Among the study population at baseline, serum Tg were significantly different in three areas [7.5 (4.4-13. 1) μg/L at Panshan, 6.8 (3.6-11.2)μg/L at Huanghua, 5.9 (3.2-10.7) μg/L at Zhangwu, P<0.01]. They were associated with age, sex and the rate of positive TgAb, abnormal thyroid volume, abnormal TSH and positive personal history of thyroid diseases, in order to control the effects of confounding factors, the data from 1856 subjects with thyroid-related indexes all in normal range and without personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. The serum Tg among three areas were significantly different in both 1999 and 2004, they were all increased in 5 years with significant augment (△ Tg) among the three areas[3.1 (-0.2-8.0) μg/L at Panshan, 3.5 (0.5-9.0)μg/L at Huanghua vs 2. 5(0.3-6.1) μg/L at Zhangwu,P<0.01]. The GLM analysis revealed that age, Tg and TSH levels at baseline were the determinants of △Tg in addition to iodine intake. Conclusion Iodine intake is a dominant determinant of serum Tg. Age and TSH should also be considered while indicating iodine intake by serum Tg.