摘要
目的 探讨甲状腺功能亢进症(甲亢)患者血清神经调节蛋白4(NRG4)水平及其临床意义。方法 选取2019年8月至2021年8月该院收治的69例甲亢患者作为甲亢组,同期收治的57例亚临床甲亢患者作为亚临床甲亢组,同期健康体检者63例为健康对照组。对甲亢患者均给予硫酰胺类药物甲巯咪唑治疗3个月。比较3组促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)水平;分析甲亢患者治疗前后的TSH、FT3、FT4、NRG4水平变化;评估治疗前血清NRG4辅助诊断甲亢的价值;分析治疗前血清NRG4水平与TSH、FT3、FT4水平的相关性。结果 甲亢组治疗前TSH水平[(0.14±0.03)mU/L]低于亚临床甲亢组[(0.25±0.04)mU/L]、健康对照组[(2.61±0.45)mU/L],甲亢组治疗前FT3、FT4、NRG4水平[(15.54±2.68)pmol/L、(41.36±10.02)pmol/L、(3.42±1.12)ng/mL]高于亚临床甲亢组[(6.25±0.27)pmol/L、(20.34±3.45)pmol/L、(2.61±0.52)ng/mL]、健康对照组[(3.74±0.39)pmol/L、(12.03±2.16)pmol/L、(1.89±0.49)ng/mL],差异均有统计学意义(P<0.05)。甲亢患者FT3、FT4、NRG4水平在治疗1个月[(12.04±2.41)pmol/L、(30.25±7.84)pmol/L、(2.84±0.87)ng/mL]、3个月[(7.65±2.23)pmol/L、(19.63±4.25)pmol/L、(2.37±0.61)ng/mL]时相比治疗前降低(P<0.05),TSH水平在治疗1个月[(0.87±0.21)mU/L]、3个月[(1.42±0.32)mU/L]相比治疗前升高(P<0.05)。受试者工作特征曲线分析结果显示:血清NRG4诊断甲亢的曲线下面积为0.859(95%CI=0.799~0.919,P<0.05),灵敏度为66.7%,特异度为88.9%,最佳临界值为2.39 ng/mL,约登指数为0.556。Pearson相关分析结果显示:NRG4水平与TSH水平呈负相关(r=-0.494,P<0.05),与FT3、FT4水平均呈正相关(r=0.502、0.644,P<0.05)。结论 甲亢患者血清NRG4呈相对高水平,硫酰胺类药物治疗后其水平下降;甲亢患者NRG4水平与甲状腺激素指标水平具有相关性,对甲亢的临床诊治具有辅助评估价值。
Objective To investigate the level and clinical significance of serum neuregulin 4(NRG4)in the patients with hyperthyroidism.Methods A total of 69 patients with hyperthyroidism admitted and treated in this hospital from August 2019 to August 2021 were selected as the hyperthyroidism group,57 patients with subclinical hyperthyroidism admitted during the same period were selected as the subclinical hyperthyroidism group,and 63 healthy subjects undergoing physical examination during the same period served as the healthy control group.All patients with hyperthyroidism were treated with sulfamide drug methimazole for 3 months.The levels of thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4)and NRG4 were compared among the three groups.The changes of TSH,FT3,FT4 and NRG4 level before and after treatment in the patients with hyperthyroidism were analyzed;the value of the serum NRG4 level before treatment in the assisted diagnosis of hyperthyroidism was evaluated.The correlation between serum NRG4 level before treatment with TSH,FT3 and FT4 levels was analyzed.Results The TSH level before treatment[(0.14±0.03)mU/L]in the hyperthyroidism group was lower than that in the subclinical hyperthyroidism group[(0.25±0.04)mU/L],healthy control group[(2.61±0.45)mU/L];the FT3,FT4 NRG4 levels in the hyperthyroidism group before treatment[(15.54±2.68)pmol/L,(41.36±10.02)pmol/L,(3.42±1.12)ng/mL]were higher than those in the subclinical hyperthyroidism group[(6.25±0.27)pmol/L,(20.34±3.45)pmol/L,(2.61±0.52)ng/mL],healthy control group[(3.74±0.39)pmol/L,(12.03±2.16)pmol/L,(1.89±0.49)ng/mL],and the differences were statistical significant(P<0.05).The levels of FT3,FT4 and NRG4 in the patients with hyperthyroidism were decreased after 1-month treatment[(12.04±2.41)pmol/L,(30.25±7.84)pmol/L,(2.84±0.87)ng/mL],3-month treatment[(7.65±2.23)pmol/L,(19.63±4.25)pmol/L,(2.37±0.61)ng/mL]compared with before treatment(P<0.05).The TSH level was increased for 1-month treatment[(0.87±0.21)mU/L]and 3-month treatment[(1.42±0.32)mU/L]compared with before treatment(P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of serum NRG4 for diagnosing hyperthyroidism was 0.859(95%CI=0.799-0.919,P<0.05),the sensitivity was 66.7%,the specificity was 88.9%,the best cut off value was 2.39 ng/mL,the Youden index was 0.556.The Pearson correlation analysis showed that the NRG4 level was negatively correlated with TSH(r=-0.494,P<0.05),and positively correlated with FT3 and FT4 levels(r=0.502,0.644,P<0.05).Conclusion The serum NRG4 level in the patients with hyperthyroidism is relatively high,and is decreased after sulfamides treatment;NRG4 level in the patients with hyperthyroidism is correlated with thyroid hormone indicators levels,and has an auxiliary evaluation value for the clinical diagnosis and treatment of hyperthyroidism.
作者
王丽萍
牛尚梅
柴巧英
刘云
史冬丹
李欣欣
胡新磊
WANG Liping;NIU Shangmei;CHAI Qiaoying;LIU Yun;SHI Dongdan;LI Xinxin;HU Xinlei(Department of Endocrinology,Handan Municipal First Hospital,Handan,Hebei 056002,China;Department of Cardiology,Handan Municipal First Hospital,Handan,Hebei 056002,China)
出处
《检验医学与临床》
CAS
2024年第14期2025-2029,共5页
Laboratory Medicine and Clinic
基金
河北省医学科学研究课题(20210232)。
