Graves病甲状腺功能亢进症131I治疗前后TGAb、TPOAb水平变化及与早发甲状腺功能减退症的关系

目的探讨Graves病甲状腺功能亢进症(简称甲亢)131I治疗前后甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)水平的变化及与早发甲状腺功能减退症(简称早发甲减)发生的关系。方法对81例Graves病患者131I治疗前依据TGAb、TPOAb水平分为阳性组(A组,46例)和阴性组(B组,35例),分别检测治疗前与治疗后6个月FT3、FT4、促甲状腺激素(TSH)、TGAb、TPOAb水平。结果A组治疗前后TGAb、TPOAb抗体水平无明显变化(P>0.05),早发甲减发生率47.8%;B组治疗后较治疗前TGAb、TPOAb水平明显升高(P<0.01),早发甲减发生率22.9%,两组131I治疗后早发甲减发生率有统计学意义(P<0.05)。早发甲减患者TSH水平与TGAb、TPOAb呈显著正相关(r=0.405,0.378,P=0.026,0.035),与甲状腺大小有一定的相关性(r=0.366,P=0.051)。结论治疗前高水平的TGAb、TPOAb早发甲减发生率明显增高,尤其是甲状腺较小者。TGAb、TPOAb阴性者131I治疗后抗体水平升高,其机制有待进一步临床观察。

Clinical observation of TGAb and TPOAb levels in early hyperthyroidism before and after 131I therapy with Graves disease

Objective To study the value of TGAb and TPOAb in patients with Graves disease before and after 131I therapy,as well as the relationship with premeture hypothyroidism.Methods 81 patients were divided into positive group(group A,46) and negative group(group B,35) according to TGAb and TPOAb levels before 131I treatment.Serum levels of TGAb and TPOAb,TSH,FT3,FT4 were measured before and six months after 131I therapy respectively.Results TGAb and TPOAb levels in group A revealed no significant difference before and after the treatment;The TGAb and TPOAb levels in group B were significantly higher after treatment than before(P<0.01).The rates of early hypothyroidism were 47.8% in group A,22.9% in group B respectively,and the rate of group A was higher than that of group B statistically(P<0.05).The serum levels of TSH in hypothyroidism had positive correlation with the levels of TGAb and TPOAb(r=0.405,0.378,P=0.026,0.035) and the thyroid mass(r=0.366,P=0.051).Conclusion The probability of early hypothyroidism is ralated to the levels of TGAb and TPOAb before 131I treatment,for patients with small thyroid glands especially.However,the mechanism of serum TGAb and TPOAb levels increased after 131I therapy needs further clinical observation.