中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
2期
110-114
,共5页
苑姗姗%于楠%高莹%黄薇%何一凡%董斌%卢桂芝%李茂蓉%蔡晓频
苑姍姍%于楠%高瑩%黃薇%何一凡%董斌%盧桂芝%李茂蓉%蔡曉頻
원산산%우남%고형%황미%하일범%동빈%로계지%리무용%채효빈
甲状腺炎%甲状腺毒症%格雷夫斯病%甲状腺球蛋白抗体%甲状腺过氧化物酶抗体
甲狀腺炎%甲狀腺毒癥%格雷伕斯病%甲狀腺毬蛋白抗體%甲狀腺過氧化物酶抗體
갑상선염%갑상선독증%격뢰부사병%갑상선구단백항체%갑상선과양화물매항체
Thyroiditis%Thyrotoxicosis%Graves disease%TgAb%TPOAb
目的 探讨Graves病(GD)、GD合并桥本甲状腺炎(GH)及桥本甲状腺毒症(HT)患者血清中甲状腺球蛋白抗体(TgAb)和甲状腺过氧化物酶抗体(TPOAb) IgG亚型的分布及意义.方法 收集2010年1月至2013年5月在北京大学第一医院、北京市海淀医院、中日友好医院和民航总医院内分泌科通过甲状腺细针穿刺细胞病理学诊断的GD(33例)、GH(31例)及HT(18例)患者的血清,采用ELISA法检测TgAb、TPOAb总IgG和各IgG亚型的百分结合率,比较各亚型的阳性率及阳性亚型的相对含量.结果 TRAb的水平在GD、GH、HT组依次为21.80(7.53,40.00) U/L、7.30(3.10,25.40) U/L、4.90(1.69,16.43) U/L,GD组明显高于GH组(P =0.000)和HT组(P=0.003),差异均有统计学意义,但三组的TRAb水平有重叠.三组间TgAb和TPOAb总IgG的水平差异均无统计学意义.TgAb IgG3亚型在HT组的阳性率(66.7％)有高于GH组(35.5％)和GD组(36.4％)的趋势(P =0.066).GD、GH、HT组TgAb IgG2阳性患者的相对含量分别为0.59(0.34,0.94)、0.31 (0.23,0.34)、0.32(0.24,0.83),GD组高于GH组(P =0.009),差异有统计学意义,GD组高于HT组(P=0.167),差异无统计学意义.GD、GH、HT组TgAb IgG4阳性患者的相对含量分别为0.57(0.28,0.97)、0.26(0.09,0.48)、0.33(0.10,0.65),GD组高于GH组和HT组(P =0.005、0.041),差异均有统计学意义.TPOAb各IgG亚型的阳性率在三组间差异无统计学意义.GD、GH、HT组TPOAb IgG2阳性患者的相对含量分别为0.39±0.04、0.29 ±0.13、0.26±0.02,GD组高于HT组(P=0.002),差异有统计学意义,GD组高于GH组(P =0.104),差异无统计学意义.结论 血清中TgAb和TPOAbIgG2或TgAb IgG4亚型相对含量高提示Graves病的可能性大,利用TgAb和TPOAb IgG亚型相对含量的差异可能为临床甲状腺毒症患者的鉴别诊断提供帮助.
目的 探討Graves病(GD)、GD閤併橋本甲狀腺炎(GH)及橋本甲狀腺毒癥(HT)患者血清中甲狀腺毬蛋白抗體(TgAb)和甲狀腺過氧化物酶抗體(TPOAb) IgG亞型的分佈及意義.方法 收集2010年1月至2013年5月在北京大學第一醫院、北京市海澱醫院、中日友好醫院和民航總醫院內分泌科通過甲狀腺細針穿刺細胞病理學診斷的GD(33例)、GH(31例)及HT(18例)患者的血清,採用ELISA法檢測TgAb、TPOAb總IgG和各IgG亞型的百分結閤率,比較各亞型的暘性率及暘性亞型的相對含量.結果 TRAb的水平在GD、GH、HT組依次為21.80(7.53,40.00) U/L、7.30(3.10,25.40) U/L、4.90(1.69,16.43) U/L,GD組明顯高于GH組(P =0.000)和HT組(P=0.003),差異均有統計學意義,但三組的TRAb水平有重疊.三組間TgAb和TPOAb總IgG的水平差異均無統計學意義.TgAb IgG3亞型在HT組的暘性率(66.7％)有高于GH組(35.5％)和GD組(36.4％)的趨勢(P =0.066).GD、GH、HT組TgAb IgG2暘性患者的相對含量分彆為0.59(0.34,0.94)、0.31 (0.23,0.34)、0.32(0.24,0.83),GD組高于GH組(P =0.009),差異有統計學意義,GD組高于HT組(P=0.167),差異無統計學意義.GD、GH、HT組TgAb IgG4暘性患者的相對含量分彆為0.57(0.28,0.97)、0.26(0.09,0.48)、0.33(0.10,0.65),GD組高于GH組和HT組(P =0.005、0.041),差異均有統計學意義.TPOAb各IgG亞型的暘性率在三組間差異無統計學意義.GD、GH、HT組TPOAb IgG2暘性患者的相對含量分彆為0.39±0.04、0.29 ±0.13、0.26±0.02,GD組高于HT組(P=0.002),差異有統計學意義,GD組高于GH組(P =0.104),差異無統計學意義.結論 血清中TgAb和TPOAbIgG2或TgAb IgG4亞型相對含量高提示Graves病的可能性大,利用TgAb和TPOAb IgG亞型相對含量的差異可能為臨床甲狀腺毒癥患者的鑒彆診斷提供幫助.
목적 탐토Graves병(GD)、GD합병교본갑상선염(GH)급교본갑상선독증(HT)환자혈청중갑상선구단백항체(TgAb)화갑상선과양화물매항체(TPOAb) IgG아형적분포급의의.방법 수집2010년1월지2013년5월재북경대학제일의원、북경시해정의원、중일우호의원화민항총의원내분비과통과갑상선세침천자세포병이학진단적GD(33례)、GH(31례)급HT(18례)환자적혈청,채용ELISA법검측TgAb、TPOAb총IgG화각IgG아형적백분결합솔,비교각아형적양성솔급양성아형적상대함량.결과 TRAb적수평재GD、GH、HT조의차위21.80(7.53,40.00) U/L、7.30(3.10,25.40) U/L、4.90(1.69,16.43) U/L,GD조명현고우GH조(P =0.000)화HT조(P=0.003),차이균유통계학의의,단삼조적TRAb수평유중첩.삼조간TgAb화TPOAb총IgG적수평차이균무통계학의의.TgAb IgG3아형재HT조적양성솔(66.7％)유고우GH조(35.5％)화GD조(36.4％)적추세(P =0.066).GD、GH、HT조TgAb IgG2양성환자적상대함량분별위0.59(0.34,0.94)、0.31 (0.23,0.34)、0.32(0.24,0.83),GD조고우GH조(P =0.009),차이유통계학의의,GD조고우HT조(P=0.167),차이무통계학의의.GD、GH、HT조TgAb IgG4양성환자적상대함량분별위0.57(0.28,0.97)、0.26(0.09,0.48)、0.33(0.10,0.65),GD조고우GH조화HT조(P =0.005、0.041),차이균유통계학의의.TPOAb각IgG아형적양성솔재삼조간차이무통계학의의.GD、GH、HT조TPOAb IgG2양성환자적상대함량분별위0.39±0.04、0.29 ±0.13、0.26±0.02,GD조고우HT조(P=0.002),차이유통계학의의,GD조고우GH조(P =0.104),차이무통계학의의.결론 혈청중TgAb화TPOAbIgG2혹TgAb IgG4아형상대함량고제시Graves병적가능성대,이용TgAb화TPOAb IgG아형상대함량적차이가능위림상갑상선독증환자적감별진단제공방조.
Objective To evaluate the distribution of IgG subclasses of TgAb and TPOAb in sera from patients with Graves' disease (GD),Graves' disease plus Hashimoto's thyroiditis (GH) and Hashimoto's thyrotoxicosis.Methods Patients with GD (n =33),GH (n =31) or Hashimoto' s thyrotoxicosis(n =18)diagnosed by fine needle aspiration cytology at Department of Endocrinology of Peking University First Hospital,Beijing Haidian Hospital,China-Japan Friendship Hospital and Civil Aviation General Hospital during the period from January 2010 to May 2013 were enrolled.All of them had TgAb and TPOAb.The total serum IgG and IgG subclasses of TgAb and TPOAb were detected by antigen-specific enzyme-linked immunosorbent assay (ELISA).The prevalence and relative amount of IgG subclasses were calculated and compared among three groups.Results The levels of TRAb in GD group (21.80 (7.53,40) U/L) were significantly higher than those in GH (7.30 (3.10,25.40) U/L) (P =0.000) and Hashimoto's thyrotoxicosis groups (4.90(1.69,16.43) U/L) (P =0.003).And no significant differences were found in the levels of TgAb and TPOAb.The prevalence of TgAb IgG3 subclass in Hashimoto' s thyrotoxicosis group (66.7％) was higher than GD group (35.5％) and GH group (36.4％) and the difference was close to significance (P =0.066).There were significant differences of relative amount of TgAb IgG2 and TgAb IgG4 among three groups (P =0.039 and 0.013),and GD patients had higher relative amounts of TgAb IgG2 (0.59 (0.34,0.94)) and TgAb IgG4 (0.57 (0.28,0.97)) than GH patients (TgAb IgG2,0.31(0.23,0.34) ; TgAb IgG4,0.26(0.09,0.48)) or patients with Hashimoto's thyrotoxicosis (TgAb IgG2,0.32(0.24,0.83); TgAb IgG4,0.33(0.10,0.65)) (for TgAb IgG2,P=0.009 and 0.167; for TgAb IgG4,P =0.005 and 0.041 respectively).No significant difference was found in the prevalence of each TPOAb IgG subclass.The difference of relative amount of TPOAb IgG2 among three groups was close to significance (P =0.069).And the relative amount was higher in sera from GD patients (0.39 ±0.04) than that in GH patients (0.29 ±0.13) or patients with Hashimoto's thyrotoxicosis (0.26 ±0.02) (P =0.104 and 0.002 respectively).Conclusion The patients with high levels of TgAb IgG2,TgAb IgG4 and TPOAb IgG2 subclasses have a greater risk of GD.The IgG subclass distribution of TgAb and TPOAb might help to differentiate the causes of thyrotoxicosis in autoimmune thyroid diseases.
