血清IGF-1联合TPOAb对甲亢患者131I治疗后早期发生甲减的预测价值

doi:10.16150/j.1671-2870.2025.05.005

摘要/Abstract

摘要：

目的： 探讨甲状腺功能亢进症（甲亢）患者血清胰岛素样生长因子1（insulin like growth factor-1， IGF-1）、甲状腺过氧化物酶抗体（thyroid peroxidase antibodies， TPOAb）、促甲状腺受体抗体（thyrotropin receptor antibodies， TRAb）、白细胞介素17（interleukin 17， IL-17）检测对¹³¹I治疗后早期（1年内）发生甲状腺功能减退症（甲减）的预测价值。方法： 收集2022年1月至2023年6月在南宁市第二人民医院核医学科接受¹³¹I治疗的121例甲亢患者，并进行1年随访。根据其接受¹³¹I治疗后是否发生甲减分为甲减组和非甲减组。比较2组治疗前一般资料、实验室指标的差异，对组间具有统计学差异的指标行二元Logistic回归分析，并绘制受试者操作特征曲线，评估这些指标预测甲亢患者行¹³¹I治疗后进展为甲减的价值。结果： ¹³¹I治疗后甲减组55例，非甲减组66例。甲减组的中位TPOAb水平为965.23 IU/mL，明显高于非甲减组（188.70 IU/mL）；而甲减组的中位IGF-1水平为140.97 ng/mL，低于非甲减组（224.28 ng/mL），差异均有统计学意义（P<0.001）。回归分析结果显示，IGF-1水平增高是甲亢患者¹³¹I治疗后发生甲减的保护因素，TPOAb水平增高则是¹³¹I治疗后发生甲减的危险因素。曲线分析显示，血清IGF-1<149.00 ng/mL预测¹³¹I治疗后早期发生甲减的曲线下面积（area under the curve，AUC）为0.827，TPOAb>473.6 IU/mL预测¹³¹I治疗后早期发生甲减的AUC为0.835，而血清IGF-1联合TPOAb预测甲亢患者¹³¹I治疗后早期发生甲减的AUC最大，数值为0.899，预测能力最强。结论： 观察甲亢患者¹³¹I治疗前的血清IGF-1联合TPOAb水平，对¹³¹I治疗后早期发生甲减具有一定的临床预测价值。

关键词: 甲状腺功能亢进症, 甲状腺功能减退症, ¹³¹I治疗, 胰岛素样生长因子, 甲状腺过氧化物酶抗体

Abstract:

Objective To explore the predictive value of serum insulin-like growth factor-1 (IGF-1), thyroid peroxidase antibodies (TPOAb), thyrotropin receptor antibodies (TRAb), and interleukin 17 (IL-17) for the occurrence of hypothyroidism after ¹³¹I treatment in patients with hyperthyroidism. Methods A total of 121 patients with hyperthyroidism who received ¹³¹I treatment in the Department of Nuclear Medicine of the Second Nanning People's Hospital from January 2022 to June 2023 were enrolled and followed up for one year. Based on the occurrence of hypothyroidism after ¹³¹I treatment, patients were divided into the hypothyroidism and non-hypothyroidism groups. The differences in general data and laboratory indicators before treatment between the two groups were compared. Binary logistic regression analysis was performed on the indicators with statistical differences between groups, and the receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of these indicators for the progression to hypothyroidism in patients with hyperthyroidism after ¹³¹I treatment. Results After ¹³¹I treatment, there were 55 cases in the hypothyroidism group and 66 cases in the non-hypothyroidism group. The median TPOAb level in the hypothyroidism group was 965.23 IU/mL, significantly higher than that in the non-hypothyroidism group at 188.70 IU/mL. Meanwhile, the median IGF-1 level in the hypothyroi-dism group was 140.97 ng/mL, lower than that in the non-hypothyroidism group at 224.28 ng/mL, with both differences being statistically significant (P<0.001). The regression analysis results showed that elevated IGF-1 level acted as a protective factor against hypothyroidism in patients with hyperthyroidism after ¹³¹I treatment, while increased TPOAb level was a risk factor. ROC curve analysis showed that an IGF-1 level <149.00 ng/mL predicted early hypothyroidism with an area under the curve (AUC) of 0.827, and a TPOAb level >473.6 IU/mL yielded an AUC of 0.835. Moreover, the combination of serum IGF-1 and TPOAb yielded the largest AUC of 0.899 for predicting hypothyroidism in patients with hyperthyroidism after ¹³¹I treatment, demonstrating the strongest predictive ability. Conclusion Observing the levels of serum IGF-1 combined with TPOAb in patients with hyperthyroidism before ¹³¹I treatment demonstrates certain clinical predictive value for the occurrence of hypothyroidism after ¹³¹I treatment.

Key words: Hyperthyroidism, Hypothyroidism, ¹³¹I treatment, Insulin-like growth factor, Thyroid peroxidase antibodies

中图分类号:

R817.8
R445

曾贝贝, 黄奕, 张步腾, 黄荣鹤, 覃丽桦, 周琦婷. 血清IGF-1联合TPOAb对甲亢患者¹³¹I治疗后早期发生甲减的预测价值[J]. 诊断学理论与实践, 2025, 24(05): 505-511.

ZENG Beibei, HUANG Yi, ZHANG Buteng, HUANG Ronghe, QIN Lihua, ZHOU Qiting. Predictive value of serum IGF-1 combined with TPOAb for the occurrence of hypothyroidism after ¹³¹I treatment in patients with hyperthyroidism[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(05): 505-511.

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Element	Hypothyroidism group	Non-hypothyroidism group	P value
Age（years）	43.27±10.201	43.38±11.174	0.086
Body mass Index（kg/m²）	20.83（19.57，23.46）	19.63（18.49，20.86）	0.004
Heart rate（beats per minute）	100.00（94.00，107.00）	97.00（89.00，107.00）	0.313
Iodine intake（mci）	5.5（5.0，6.55）	6.1（5.0，6.6）	0.141
TT₃（nmol/L）	4.89（3.03，6.04）	5.23（3.58，8.14）	0.061
FT₃（pmol/L）	15.96（8.58，23.60）	17.81（10.46，30.72）	0.123
TT₄（nmol/L）	215.19（171.43，268.89）	206.76（159.63，283.86）	0.639
FT₄（pmol/L）	36.11（24.18，50.79）	37.16（26.32，51.87）	0.763
TSH（uIU/mL）	0.0028（0.0015，0.0040）	0.0026（0.0013，0.0047）	0.460
TPOAb（IU/mL）	965.23（583.96，1537.66）	188.70（40.85，556.50）	<0.001
TRAb（IU/mL）	24.80（10.64，30.175）	25.62（11.18，33.23）	0.551
IGF-1（ng/mL）	140.97（113.37，196.31）	224.28（172.86，277.99）	<0.001
IL-17（pg/mL）	9.12（7.52，11.87）	10.55（8.37，12.38）	0.058

Factor	Regression coefficient （B）	Wald	0R value	95％CI	P value
Body mass index	0.216	3.463	1.241	0.989-1.558	0.063
TPOAb	0.020	15.179	1.002	1.001-1.003	<0.001
IGF-1	-0.026	17.743	0.974	0.962-0.986	<0.001

血清IGF-1联合TPOAb对甲亢患者¹³¹I治疗后早期发生甲减的预测价值

Predictive value of serum IGF-1 combined with TPOAb for the occurrence of hypothyroidism after ¹³¹I treatment in patients with hyperthyroidism

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