血清甲状腺过氧化物酶抗体阳性患者致病因素分析

目的：观察甲状腺过氧化物酶抗体（TPOAb）阳性人群性别、年龄及TPOAb水平与甲状腺疾病（TD）产生的相关性,以指导临床对AITD的诊断和治疗。方法：对用电化学发光检测TPOAb阳性352例患者结合临床表现及甲状腺功能检查分为三组：甲亢组103例、甲减组98例、甲状腺功能正常且无临床表现组151例（以下简称无表现组）,健康人群50例为对照组,比较四组人群的TPOAb水平及观察TPOAb阳性各组的年龄、性别及发病比例。结果：甲减组、甲亢组、无表现组与对照组TPOAb水平差异显著（P〈0.01）;甲减组、甲亢组与无表现组TPOAb水平差异显著（P〈0.05）;甲减组与甲亢组TPOAb水平无显著差异（P〉0.05）;TPOAb阳性人群男、女性别比约为1∶4;甲减组平均年龄51.7±14.8岁,甲亢组平均年龄37.4±13.7岁;TPOAb阳性人群中51.7%患甲状腺疾病。结论：性别、年龄、血清TPOAb滴度均与血清甲状腺过氧化物酶抗体阳性患者甲状腺疾病产生有一定的相关性。     

甲状腺刺激性抗体、碘摄入量与亚临床甲亢发病及预后的关系

目的:探讨甲状腺刺激性抗体(TSAb)、碘摄入量对亚临床甲状腺功能亢进症(亚临床甲亢)的发病及预后的影响。方法:测定三个不同碘摄入量地区115例亚临床甲亢患者的血清TSAb、促甲状腺激素结合抑制免疫球蛋白(TBII)、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb),2年后随访。TSAb采用转染了重组人促甲状腺素受体的中国仓鼠卵巢细胞(rhTSHRCHOcell)生物法测定。结果:亚临床甲亢患者TSAb活性为(157.34±121.61)%,TSAb阳性率22.6%,均显著高于对照组(均P<0.001)。TSAb阳性患者中,53.9%TPOAb和或TgAb阳性;TPOAb和TgAb均阴性患者中,TSAb阳性率15.4%。TSH>0.2mUL、0.2～0.05mUL、<0.05mUL3组患者比较,TSAb阳性率和活性递增,甲状腺肿大(简称甲肿)率和甲状腺体积递减(P<0.05)。亚临床甲亢患者TSAb与TSH负相关、与甲状腺球蛋白(Tg)正相关。碘过量地区亚临床甲亢患者TSAb活性和阳性率显著高于碘充足和碘缺乏地区(P<0.05)。TSAb转阴或降低(OR=0.36,P=0.045)、初访甲状腺无肿大(OR=0.33,P=0.027)为亚临床甲亢缓解的有利因素。甲状腺功能(简称甲功)恢复者与未恢复者比较,尿碘浓度无差异。结论:自身免疫因素是碘过量地区亚临床甲亢的主要原因。血清TSAb和甲状腺体积决定亚临床甲亢的预后。碘摄入量对亚临床甲亢的预后无影响。     

自身免疫性甲状腺疾病患者甲状腺自身抗体与纤维化四项联检的临床价值分析

目的探讨利用自身免疫性甲状腺疾病患者中,血清甲状腺过氧化物酶抗体(TPOAb)及甲状腺球蛋白抗体(TgAb)水平联合血清纤维化四项检测,评价甲状腺组织纤维化的临床价值分析。方法选取我院就诊的174例患者,甲状腺相关自身抗体异常增高作为病例组;选取在我院体检科健康体检者25例,甲状腺相关自身抗体均正常作为对照组。采用化学发光法测定TPOAb、TgAb;采用放射免疫法检测纤维化四项包括:血清层黏蛋白(LN)、血清透明质酸(HA)、血清Ⅲ型前胶原氨端肽(PⅢNP)、血清IV胶原(CIV)。采用SPSS 21.0软件进行方差分析(ANOV)和t检验;Pearson相关性分析TPOAb、TgAb分别与纤维化四项的关系。结果阳性组与对照组、超声影像不同表现组比较,纤维化指标水平差异无统计学意义;血清TPOAb、TGAb分别与PⅢNP、CIV、LN、HA进行相关性分析(P>0.05),呈显著无相关。结论甲状腺自身抗体异常患者,甲状腺功能正常情况下,纤维化指标检测用于判断甲状腺纤维化的意义不大。     

曲安西龙可促进桥本氏病伴甲减的甲状腺功能恢复

目的:研究曲安西龙对桥本氏病伴甲减的疗效。方法:桥本氏病伴甲减患者共60例,随机分为曲安西龙组和对照组。两组于治疗前及治疗后4个月时分别测定血清游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺素(TSH)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)、血浆皮质醇、促肾上腺皮质激素及血浆葡萄糖水平。结果:治疗后曲安西龙组TSH较对照组显著改善(P均<0.05),TgAb和TPOAb也明显下降(P均<0.05),且治疗所需左旋甲状腺素的平均剂量为39±20μg/d,明显低于对照组(P<0.05)。结论:曲安西龙能明显降低血清TgAb和TPOAb水平,增强左旋甲状腺素对桥本氏病伴甲减的疗效,更快恢复甲状腺功能。     

甲状腺激素自身抗体检测的意义

目的:检测不同人群血清中的甲状腺激素自身抗体(THAAb)探讨其临床价值。方法:检测甲状腺功能正常的血清107例、甲亢血清56例、甲减血清34例,分别检测其THAAb和甲状腺抗体。结果:甲状腺功能正常组阳性率2.80%,甲亢组阳性率5.35%,甲减组阳性率5.88%。结论:THAAb阳性可影响临床检测的一致性,对临床检测有重要意义。     

甲状腺过氧化物酶抗体在甲亢、甲状腺占位性病变诊治中的临床意义

目的观察不同临床治疗阶段甲亢、甲状腺占位性病变患者血清甲状腺过氧化物酶抗体(TPOAb)浓度的变化,探讨其临床指导价值。方法采用固相化学发光酶免疫分析法观察血清TPOAb浓度变化与甲状腺功能减退(化验室检查结果)的关系。结果89例患者中,有50例患者治疗前TPOAb正常或仅轻度增高,治疗后呈现阳性者31例,其中19例发生了甲减或亚临床型;39例治疗前TPOAb阳性,治疗后转阴2例,26例浓度降低,发生甲减3例,29例患者服用不同剂量的甲状腺片而未出现甲减或亚临床型。结论甲亢和甲状腺占位性病变患者在治疗过程可伴有TPOAb浓度的变化,TPOAb的明显增高,预示出现甲减的可能性大,TPOAb阳性的患者应被关注,高滴度TPOAb的甲亢患者治疗方案的选择要慎重。     

弹性成像SR值、最大血流速度、TPOAb、TgAb应用于桥本氏甲状腺炎临床诊断的研究

目的:研究弹性成像应变率比值(SR)、最大血流速度、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)应用于桥本氏甲状腺炎的临床诊断.方法:选取我院收治的86例桥本氏甲状腺炎患者作为实验组,根据甲状腺功能分为甲亢组(n=32)、甲减组(n=25)以及单纯甲状腺肿组(n=29).并选取同期86例健康体检者作为对照组(n=86).所有入选者均接受弹性成像超声和血清学检查.对比实验组和健康组弹性成像超声指数和TPOAb、TgAb及促甲状腺激素(TSH)水平;对比不同甲状腺功能患者的SR值、最大血流速度和TPOAb、TgAb水平、TSH;分析SR值、最大血流速度和TPOAb、TgAb与TSH的相关性.结果:与对照组相比,实验组SR值显著降低,最大血流速度、TPOAb、TgAb和TSH显著增高(P<0.05).与单纯甲状腺肿组相比,甲亢组SR值和TSH水平显著更低,最大血流速度、TPOAb、TgAb和TSH显著更高,甲减组SR值显著更低,最大血流速度、TPOAb、TgAb和TSH显著更高(P<0.05);与甲减组相比,甲亢组患者SR值和TSH水平显著更低,最大血流速度、TPOAb、TgAb和TSH显著更高(P<0.05).结论:桥本氏甲状腺炎患者的SR值、最大血流速度TPOAb以及TgAb均存在明显的变化.患者在不同甲状腺功能中也存差异性,临床上可将SR值、最大血流速度TPOAb以及TgAb作为桥本氏甲状腺炎诊断的辅助方法.     

HT患者血清TGA、TPOAb RIA与ECLEIA对比

目的:研究用定量的方法检测患者体内自身抗体对不同症状桥本氏甲状腺炎(HT)的临床诊断价值.方法:应用增强化学发光酶免分析(ECLEIA)检测不同临床症状HT患者体内的甲状腺球蛋白抗体(TGA)和甲状腺过氧化物酶抗体(TPOAb)的含量,同时用RIA方法作对比.结果:HT伴甲亢组12例TGA含量:(621±245)IU/ml 阳性率83.3%,RIA阳性率:66.7%;TPOAb含量:(452±203)IU/ml阳性率100%,RIA阳性率:75.0% ;HT伴甲减组50例 TGA含量:(1152±420) IU/ml 阳性率94.0%,RIA阳性率:88.0%; TPOAb含量:(482±302)IU/ml阳性率96.0%,RIA阳性率:90.9%; HT伴甲功正常组63例 TGA含量:(230±186) IU/ml 阳性率58.7%, RIA阳性率:38.1% ;TPOAb含量:(302±201)IU/ml阳性率92.1%,RIA阳性率:63.5%.结论:定量分析患者血清中TGA和TPOAb 含量,大大提高了HT的诊断率,避免了把不同临床症状的HT患者漏诊或误诊.     

TPO-Ab在甲状腺自身免疫性疾病中的应用

目的：探讨甲状腺过氧化物酶抗体（TPO-Ab）在甲状腺功能亢进（甲亢）、甲状腺功能减退（甲减）、单纯性甲状腺肿大患者的临床价值。方法：采用放射免疫分析检测甲状腺疾病患者血清TGA、TMA、TPO-Ab浓度及血清FL、FT4、TSH水平,分析TPO-Ab在69例甲亢、53例甲减及45例单纯性甲状腺肿的阳性率。结果：TPO-Ab的阳性率（82％-92．5％）明显高于同组的TGA（44．2％）、TMA（69．8％）,甲减组TPO-Ab的阳性值（平均57．4％）明显高于甲亢组（31．2％）和单纯甲状腺肿组（17．6％）,差异有显著意义（P〈0．01）。结诊!TPO-Ab对自身角癌件甲状腺疾病的诊断、治疗和预后评估具右一定的临床价值．     

浙江省玉环县海岛地区血清甲状腺球蛋白抗体和过氧化物酶浓度调查

目的了解玉环县海岛地区人群的血清甲状腺球蛋白抗体和过氧化物酶水平及探讨本地区自身免疫性甲状腺疾病多发的原因。方法 anti-TgAb、anti-TPOAb使用美国雅培公司生产的AXSYM全自动化学发光仪以及配套的进口试剂,方法采用微拉子酶免疫法MEIA进行定量测定血清甲状腺球蛋白抗体和甲状腺过氧化物酶浓度。结果甲状腺球蛋白抗体总的阳性率为32%,男性和女性的阳性率分别为28%、32%,男性和女性之间存在明显差异(P<0.05),各年龄组除41岁到50岁组与>61岁组存在显著性差异(P<0.05)外,其余均无显著性差异(P>0.05);甲状腺过氧化物酶抗体总的阳性率为35%,男性和女性的阳性率分别为34.6%、30.4%,男性和女性之间存在明显差异(P<0.05),各年龄组均无显著性差异(P>0.05)。结论本地区人群甲状腺自身抗体的高阳性率可能与当地高碘饮食,以及遗传易感性、生物因素、化学因素等环境因素有关。     

Juvenile onset systemic lupus erythematosus thyroid dysfunction: A subgroup with mild disease?

The aim of this study was to evaluate the frequency of thyroid dysfunction and thyroid antibodies in patients with juvenile onset Systemic Lupus Erythematosus (JOSLE) and its association with clinical and immunological features. Seventy-seven patients with JOSLE, 64 females, median age 19 years, were consecutively enrolled from March to December 2007. Clinical data related to thyroid dysfunction and lupus were obtained by chart review and patient interview. Serum levels of TSH, free T4, anti-thyroglobulin (TgAb), anti-thyroperoxidase (TPOAb), TRAb and lupus related autoantibodies were analyzed by standard techniques. Nine patients were diagnosed as hypothyroidism and 4 hyperthyroidism. 28% JOSLE patients had moderate/high titer of thyroid antibodies: 23% TgAb, 2.6% TPOAb and 3.9% TRAb. JOSLE patients with positive thyroid autoantibodies had higher frequency of anti-U1RNP antibodies than patients without these antibodies (40.9 vs. 14.5%, OR:0.25, CI:0.08–0.76, p = 0.017). Furthermore, renal/neurological/hematological involvement was less frequently observed in patients with hypothyroidism (55.6 vs. 87.5%, OR:0.18, CI:0.04–0.81, p = 0.035) and with thyroid antibodies (68.4 vs. 90.9%, OR:0.22, CI:0.06–0.82, p = 0.027) than in patients without these alterations. No association with PTPN22 polymorphism was found. In conclusion, JOSLE patients have high prevalence of subclinical hypothyroidism. The novel association of anti-thyroid antibodies with anti-U1RNP antibodies in JOSLE seems to identify a subgroup of patients with less life-threatening organ involvement.     

聚乙二醇干扰素α治疗慢性乙型肝炎诱发甲状腺疾病的临床研究

目的 探讨聚乙二醇干扰素α治疗慢性乙型肝炎期间甲状腺疾病发生情况及其临床特点.方法 对210例应用聚乙二醇干扰素α治疗的慢性乙肝患者在治疗前、治疗中每3个月检测甲状腺功能及甲状腺抗体.结果 聚乙二醇干扰素α治疗后,6.7％(14/210)出现甲状腺疾病,其中5.2％ (11/210)甲状腺功能亢进,1.4％(3/210)甲状腺功能减退.女性发生甲状腺功能亢进及甲状腺功能减退的比例分别为11.8％ (6/51)和3.9％ (2/51),高于男性的3.1％ (5/159)和0.6％ (1/159),两组间差异有统计学意义,P＜0.05.女性、治疗前TPOAb阳性及治疗中TgAb阳性患者出现甲状腺疾病比例增高,与未出现甲状腺疾病者相比,差异有统计学意义,P＜ 0.05.结论 聚乙二醇干扰素α治疗慢性乙型肝炎可引起甲状腺疾病.女性、TPOAb及TgAb阳性患者发生甲状腺疾病的风险增高.     

体检人群甲状腺激素水平调查

目的 调查体检人群甲状腺激素水平,为健康指导及防治甲状腺疾病提供帮助.方法 采用微粒子化学发光法检测体检人群TSH、FT3和FT4.结果 ①随着年龄的增长,各年龄组TSH平均浓度呈上升趋势,FT3平均浓度呈下降趋势;②各年龄组甲状腺激素异常检出率存在差异.其中男性随着年龄的增长甲状腺激素异常检出比例呈上升趋势,年龄与患病率成较高的相关性;③＞ 50岁的人群甲减和亚甲减的患病率显著高于≤50岁的人群,差异有统计学意义（P＜0.05）;④女性甲状腺疾病患病率高于男性,其中甲减、亚临床甲减和甲亢的患病率差异具有统计学意义（P＜0.01）.结论 除了61～ 70年龄组的女性人群出现偏离外,所有男性组和其余各年龄段女性组,随着年龄的增长甲状腺激素异常检出比例总体呈上升趋势.50岁以上人群尤其是女性是患甲状腺疾病的高危人群,且甲状腺疾病多以甲状腺功能减退症和亚临床甲状腺功能减退症为主.     

Thyroid function tests

About 80% of thyroid disease consists of thyroid-specific autoimmune diseases, Hashimoto's disease and Grave's disease. To diagnose thyroid diseases, testings for (1) thyroid function and (2) pathogenetic autoantibodies are indispensable. To assess thyroid function, serum hormone concentrations, such as TSH, FT4 and FT3 are measured. Among these hormones, serum TSH concentrations are the most reliable and informative regarding thyroid function, correcting indicating a hyperthyroid, euthyroid or hypothyroid state. Therefore, TSH measurement appears to be the first choice in selecting the hormone determination. Reference intervals for normal healthy subjects of TSH are around 0.4-5.0 microU/ml. The second choice for thyroid function assessment are FT4 which supersedes total T4(TT4). TT4 is affected by changes in serum thyroid hormone binding proteins(TBG, TTR, Albumin). For example, euthyroid pregnant women whose serum TBG are physiologically higher than those of non-pregnant women show augmentation of TT4. However, FT4 depicts within reference intervals, although measurement of FT4 alone is unable to detect any abnormality of thyroid hormone binding proteins. According to its plasma concentration and binding affinity, FT3 measurement deserves no more significance than T3. Another important test for thyroid diseases is to detect serum autoantibodies against thyroid tissues, such as TgAb, TPOAb. Much more important is TSH receptor antibody which differentiates Graves' disease from Hashimoto's thyroiditis. In patients who show hyperthyroidism and some very uncommon hypothyroidism, TSH receptor antibodies should be measured. Three indicators are available as routine tests; TRAb measured by radioreceptor assay; TSAb determined by bioassay using cultured porcine thyroid cells. Usually, TRAb activity clinically correlates well with TSAb. TSBAb was initially discovered in patients with severe hypothyroidism with atrophic thyroid gland. TSBAb blocks thyroid stimulating activity of TSH and consequently causes severe hypothyroidism. TRAb and TSAb are very useful to diagnose and follow patients with Grave's disease.     

Thyroid peroxidase and thyroglobulin auto-antibodies in patients with newly diagnosed overt hypothyroidism

OBJECTIVES: Thyroid autoimmunity is a major cause for hypothyroidism. We describe thyroid auto-antibodies in patients with various nosological subtypes of hypothyroidism identified in a population study. DESIGN: Population-based follow-up study identifying all new cases of hypothyroidism in an open cohort. METHODS: We established a monitoring system, and identified all new cases with primary overt hypothyroidism (n = 685) in a 4 year period in a well-defined population cohort (2,027,208 person-years of observation). Patients were sub-classified into: spontaneous hypothyroidism, presumably of autoimmune origin (n = 578); non-spontaneous hypothyroidism (associated with medication, delivery, neck-irradiation or subacute thyroiditis, n = 97); and congenital hypothyroidism (n = 10). A total of 186 adult patients (61% of those invited) underwent thyroid ultrasonography and measurements of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb). RESULTS: In spontaneously hypothyroid patients: >99% were antibody-positive (TPOAb or TgAb), TPOAb were more often measurable than TgAb (95.9 vs. 80.7%, p < 0.001). A statistically significant but modest correlation was observed between the two antibodies (Pearson's r2 = 0.11, p < 0.001). In a multivariate regression model both TPOAb and TgAb were positively associated with thyroid enlargement (p < 0.001), whereas no association was found with sex, age, iodine deficiency level or serum TSH level. We found no differences in patient characteristics between those who mainly developed TPOAb vs. those who preferentially harboured TgAb. CONCLUSIONS: Autoimmunity played a dominant role in practically all patients classified as spontaneously hypothyroid. Thyroid enlargement was associated with high levels of TPOAb and TgAb. We found no clue to why some spontaneously hypothyroid patients predominantly developed TPOAb whereas others mainly generated TgAb.     

桥本氏甲状腺炎患者外周血中CD4+ CD45RO+ 记忆性T 细胞的表达及意义

目的:检测初诊桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT)患者外周血CD4+ CD45RO+ 记忆性T 细胞比例,探讨其在HT 发病中的意义。方法:收集初诊的HT 患者作为病例组(HT,n =53),另外选取年龄、性别相匹配的正常人作为对照组(HC,n =43),并根据甲状腺功能状态将HT 组分为甲状腺功能正常组(HT-A,n =15)、亚临床甲减组(HT-B,n =14)和临床甲减组(HT-C,n =24)。流式细胞仪检测外周静脉血中CD4+ CD45RO+记忆性T 细胞比例,酶联免疫吸附法检测血清中IFN 、IL-17 水平,化学发光法检测甲状腺功能及甲状腺特异性抗体滴度。结果:HT 组外周血中CD4+ CD45RO+ 记忆性T 细胞比例、IFN 、IL-17、TPOAb 与TgAb 水平均显著高于HC 组,P<0.01。双变量相关分析显示HT 患者外周血CD4+ CD45RO+记忆性T 细胞的比例与IFN 、TPOAb、TgAb 均呈正相关(P<0.01,P =0.015,P<0.01)。结论:CD4+ CD45RO+ 记忆性T 细胞在HT 患者外周血中呈高表达,CD4+ CD45RO+记忆性T 细胞可能参与了HT 的发病过程。     

孕前及孕期甲状腺功能减退筛查的临床分析

目的探讨甲状腺功能减退与不良孕史的相关性及孕期甲状腺功能减退筛查的意义。方法选取2010年10月-2011年8月期间在我院门诊就诊的生育年龄妇女共243例,采用化学发光（CIA）进行甲状腺功能激素系列（TSH、FT4、TPOAb）测定。结果不良孕史中甲状腺功能低下所占比例明显高于无不良孕史组;亚临床甲状腺功能低下在临床上发生率相对较高。结论甲状腺功能减低与不良孕史有明显相关性;要重视亚临床甲状腺功能低下的发生;进行孕期甲状腺功能筛查很有必要。     

Graves病131I治疗后一年内缓解和早发甲减患者血清IL-18和TRAb的变化分析

探讨131I治疗后一年内GD患者甲减的免疫功能状态的改变.采用CLIA、IRMA和EIA方法,监测41例GD患者131I治疗前后血清白细胞介素-18(IL-18)、促甲状腺素受体抗体(TRAb)、TPOAb的含量和甲状腺重量(TDW)变化.41例GD患者分为甲减组13例和缓解组28例.结果表明治疗前两组GD患者血清IL-18和TRAb水平明显升高,与对照组比较均有显著性差异(P＜0.01,P(0.05),两组间比较,血清FT3、FT4、sTSH、TDW和131I剂量均无显著性差异(P＞0.05).治疗后两组血清IL-18明显下降,甲减组血清sTSH升高明显(P＜0.01),而缓解组TDW明显减少(P＜0.05).两组患者治疗后的TRAb水平仍然较高(P＜0.05).IL-18与FT3、FT4和TDW呈正相关(r=0.372,P＜0.01;r=0.312,P(0.01;r=0.371,P＜0.01),与sTSH呈负相关(r=-0.224,P＜0.01).甲减组TPOAb升高的病例治疗前为4/13,治疗后为6/13;缓解组治疗前为10/28,治疗后为12/28.131I治疗后6～12个月内辐射对患者免疫系统的调控产生的直接影响较小,血IL-18含量变化如结合TRAb、TPOAb指标了解甲状腺Th1/Th2型免疫应答状态,对疗效观察和预后判断有阶段性指导作用.     

孕前及孕期妇女甲状腺功能减退筛查的临床分析

目的探讨甲状腺功能减退与不良孕史的相关性及孕期甲状腺功能减退筛查的意义。方法选取2010年10月-2011年8月期间在我院门诊就诊的生育年龄妇女共243例,采用化学发光（CIA）进行甲状腺功能激素系列（TSH、FT4、TPOAb）测定。结果不良孕史中甲状腺功能低下所占比例明显高于无不良孕史组;亚临床甲状腺功能低下在临床上发生率相对较高。结论甲状腺功能减低与不良孕史有明显相关性;要重视亚临床甲状腺功能低下的发生;进行孕期甲状腺功能筛查很有必要。