摘要
目的比较促甲状腺素受体抗体(TRAb)和促甲状腺素受体刺激性免疫球蛋白(TSI)对Graves病(GD)的诊断效率,并通过分析两者与甲状腺激素水平的相关性,比较两者评估GD甲状腺功能的临床效能。方法以660例健康体检者为对照组,检测血清TRAb和TSI水平。收集2021年至2022年到我院就诊的GD初发未治疗的患者(Graves disease-untreated,GD-UT)121例,检测初诊时血清TRAb、TSI与血清游离三碘甲状原氨酸(FT_(3))、游离甲状腺素(FT_(4))、三碘甲状腺原氨酸(TT_(3))和血清总甲状腺素(TT_(4))的水平。分析对照组与GD-UT组血清TRAb和TSI数据,绘制受试者工作特征曲线(ROC)并确定cut-off值,比较两指标诊断GD的临床效能。分析TRAb和TSI与FT_(3)、FT_(4)、TT_(3)、TT_(4)的相关性,用SPSS 13.0软件对各指标进行Pearson相关分析,以P<0.05为有线性相关关系,以R 2表示相关性的大小,比较两者评估GD甲状腺功能的效能。结果对照组与GD-UT组统计显示,TRAb对诊断GD的灵敏度和特异性分别为99.17%和99.39%;TSI对诊断GD的灵敏度和特异性分别为100%和99.7%。ROC曲线分析显示,TRAb的曲线下面积(AUC)为0.991,TSI的AUC为0.995。统计分析显示TRAb与FT_(3)、FT_(4)、TT_(3)、TT_(4)均无线性相关关系,当TSI<30IU/L时,TSI与FT_(3)、FT_(4)、TT_(3)、TT_(4)有线性相关关系,且为正相关,P值均<0.0001,R^(2)分别为0.33、0.26、0.30和0.29,当TSI≥30IU/L时,TSI与FT_(3)、FT_(4)、TT_(3)、TT_(4)均无线性相关关系。结论TRAb和TSI对诊断GD均有较高的灵敏度和特异性。GD初发患者血清TRAb与FT_(3)、FT_(4)、TT_(3)、TT_(4)均无线性相关关系,当TSI<30IU/L时,TSI与FT_(3)、FT_(4)、TT_(3)、TT_(4)有线性正相关关系,在用免疫指标评估GD甲状腺功能时,TSI显示出比TRAb更优的临床性能。
Objective To compare the diagnostic efficiency of thyrotropin receptor antibody(TRAb)and thyrotropin receptor stimulating immunoglobulin(TSI)in Graves′disease(GD),and to evaluate the clinical efficacy of thyroid function in GD by analyzing the correlation between the two markers and thyroid hormone level.Methods Serum levels of TRAb and TSI were measured in 660 healthy people as the control group.121 patients with GD who were initially untreated(GD-UT)from 2021 to 2022 were recruited and the levels of serum TRAb,TSI,free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),triiodothyronine(TT_(3))and total thyroxine(TT_(4))were measured at the initial diagnosis.We analyzed serum TRAb and TSI data of the control group and GD-UT group,drew the subject working characteristic curve(ROC)and determined the cut-off value,and compared the clinical efficacy of the two indicators in diagnosing GD.The correlation between TRAb and TSI and FT_(3),FT_(4),TT_(3) and TT_(4) was analyzed.Pearson correlation analysis was performed on each index with SPSS 13.0.P<0.05 was the linear correlation cut-off value,and R^(2) was considered as the size of the correlation.The efficacy of the two indexes in evaluating GD thyroid function was compared.Results Statistics of the control group and GD-UT group showed that the sensitivity and specificity of TRAb in diagnosing GD were 99.17%and 99.39%respectively;The sensitivity and specificity of TSI in diagnosing GD were 100%and 99.7%respectively.ROC curve analysis showed that the area under the curve(AUC)of TRAb was 0.991,and AUC of TSI was 0.995.Statistical analysis showed that TRAb had no linear correlation with FT_(3),FT_(4),TT_(3),and TT_(4).When TSI was less than 30IU/L,TSI had a linear correlation with FT_(3),FT_(4),TT_(3),and TT_(4),and was positively correlated.All P values were<0.0001,and R 2 were 0.33,0.26,0.30,and 0.29,respectively.When TSI≥30IU/L,TSI had no linear correlation with FT_(3),FT_(4),TT_(3),and TT_(4).Conclusion Both TRAb and TSI have high sensitivity and specificity in the diagnosis of GD.There is no linear correlation between serum TRAb and FT_(3),FT_(4),TT_(3) and TT_(4) in patients with GD.When TSI is less than 30IU/L,TSI has a linear positive correlation with FT_(3),FT_(4),TT_(3) and TT_(4).When evaluating GD thyroid function with immune indicators,TSI shows a better clinical performance than TRAb.
作者
崔雄鹰
胡杰
阴振晨
赵晋华
CUI Xiongying;HU Jie;YIN Zhenchen;ZHAO Jinhua(Department of Nuclear Medicine,First People’s Hospital Affiliated to ShanghaiJiaotong University School of Medicine,Shanghai 201620,China)
出处
《标记免疫分析与临床》
CAS
2023年第3期481-486,共6页
Labeled Immunoassays and Clinical Medicine
