论著

甲状腺功能血清学指标结合超声检查在鉴别儿童毒性弥漫性甲状腺肿与慢性淋巴细胞性甲状腺炎中的价值

展开
  • 1.南京医科大学附属儿童医院a. 检验科,b. 超声诊断科,c. 内分泌科, 江苏 南京 210008
    2.南京医科大学医学遗传学系,江苏 南京 211166

收稿日期: 2019-01-05

  网络出版日期: 2022-07-14

基金资助

南京医科大学科技发展基金(NMUB2018118)

Value of serological parameters of thyroid function in combination with ultrasound examination for differentiating Graves disease from Hashimoto thyroiditis in children

Expand
  • 1a. Department of Clinical Laboratory, 1b. Department of Ultrasound Diagnosis, 1c. Department of Endocrinology, Children's Hospital of Nanjing Medical University, Jiangsu Nanjing 210008, China
    2. Faculty of Medical Genetics, Nanjing Medical University, Jiangsu Nanjing 211166, China

Received date: 2019-01-05

  Online published: 2022-07-14

摘要

目的: 分析毒性弥漫性甲状腺肿[又称格雷夫斯病(Graves disease, GD)]和慢性淋巴细胞性甲状腺炎[又称桥本甲状腺炎(Hashimoto thyroiditis,HT)]患儿的甲状腺功能血清学指标和超声检查表现,为临床鉴别儿童GD与HT甲状腺功能亢进(甲亢)期提供依据。方法: 选取2016年1月至2019年12月间南京医科大学附属儿童医院内分泌科确诊的GD和HT患儿共226例(年龄为7~14岁),其中GD组患儿124例, HT甲亢组患儿38例,HT甲状腺功能减退(甲减)组患儿64例。另选200名同期且年龄匹配的健康体检儿童作为对照组。用电化学发光免疫测定检测患者及对照者的甲状腺功能血清学指标,包括游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺素 (thyroid stimulating hormone,TSH)、抗甲状腺过氧化物酶自身抗体(anti-thyroid peroxidase autoantibody,anti-TPOAb)、抗甲状腺球蛋白抗体(anti-thyroglobulin antibody,anti-TGAb)、促甲状腺激素受体抗体 (thyroid stimulating hormone receptor antibody,TRAb)。同时记录患者及对照者的甲状腺超声检查指标,包括甲状腺左右叶横径及前后径、峡部前后径和彩色多普勒血流成像(color Doppler flow imaging,CDFI),比较GD组与HT甲亢组间上述临床数据的差异。结果: 与HT甲亢组比较,GD组患儿TRAb水平升高[(18.98±20.11) IU/L比(0.33±0.41) IU/L],anti-TPOAb[(176.10±188.84) IU/mL比(219.65±203.66) IU/mL]和anti-TGAb[(242.40±632.15) IU/mL比(471.56±361.12) IU/m]水平降低。进一步分析3种甲状腺自身抗体的阳性率,结果发现,GD组的TRAb阳性率(93%)高于HT甲亢组(33%),HT甲亢组的anti-TPOAb(93%)和anti-TGAb(84%)阳性率高于GD组(52%和49%)(P均<0.05)。与HT甲亢组(35%)相比,GD组CDFI报告血流丰富率高(94%)(P<0.05),余超声指标无差异。结论: 儿童GD与HT甲亢期的临床表现相近,超声检查提示肿大甲状腺体积相近;患儿的TRAb水平升高和CDFI报告血流丰富时,多提示为GD;当anti-TPOAb、anti-TGAb水平升高和CDFI报告血流不丰富时,则多提示患儿为HT甲亢期。鉴别二者时,超声CDFI检测血流可提供鉴别GD与HT甲亢期的参考信息。

本文引用格式

李松涛, 杨大恒, 孙杭, 岳玉林, 张倩, 刘倩琦, 武苏, 马长艳 . 甲状腺功能血清学指标结合超声检查在鉴别儿童毒性弥漫性甲状腺肿与慢性淋巴细胞性甲状腺炎中的价值[J]. 诊断学理论与实践, 2020 , 19(06) : 600 -604 . DOI: 10.16150/j.1671-2870.2020.06.010

Abstract

Objective: To analyze the serological parameters of thyroid function and features of ultrasound examination in pediatric patients with Graves' disease (GD) and Hashimoto thyroiditis (HT) so as to provide evidence for the differential diagnosis of the two diseases. Methods: A total of 226 children (aged from 7-14 years) from January 2016 to December 2019 at Children's Hospital of Nanjing Medical University were enrolled, including 124 GD children (GD group) and 102 HD (HD group). HD children were further divided into HT with hyperthyroidism (HT with hyperthyroidism group, 38 cases) and HT with hypothyroidism (HT with hypothyroidism group, 64 cases). Two hundred healthy children with matching age were served as controls. Free triiodothyronine(FT3), free thyroxine(FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase autoantibody(anti-TPOAb), anti-thyroglobulin antibody(anti-TGAb) and thyroid stimulating hormone receptor antibody(TRAb) were detected with electrochemiluminescence immunoassay(ECLIA). Indices of ultrasonography including transverse diameter and anteroposterior diameter of right and left lobes of thyroid, isthmic anteroposterior diameter were measured, and blood flow in thyroid was detected by color Doppler flow imaging (CDFI). Both the thyroid function serological parameters and features of ultrasound examination were compared between the four groups. Results: Compared with HT with hyperthyroidism group, GD group had an increased TRAb level [(18.98±20.11) IU/mL vs. (0.33±0.41) IU/L] but lower levels of anti-TPOAb [(176.10±188.84) IU/mL vs. (219.65±203.66) IU/mL] and anti-TGAb[(242.40±632.15) IU/mL vs. (471.56±361.12) IU/mL]. A further analysis showed that the positive rate of TRAb in GD group was higher than that in HT with hyperthyroidism group, while HT with hyperthyroidism group had higher positive rates of anti-TPOAb(93% vs 52%) and anti-TGAb(84% vs 49%). Percentage of GD group with rich blood flow detected by CDFI(94%) was higher than that of HT patients with hyperthyroidism group(35%)(P<0.05). Conclusions: GD pediatric patients have similar clinical features and size of thyroid with those of HT with hyperthyroidism, which make it difficult to differentiate. Patients with higher TRAb level and abundant blood flow by CDFI imply a high possibility of GD, while those with increased levels of anti-TPOAb, anti-TGAb and non-abundant blood flow by CDFI are likely to have HT with hyperthyroidism. CDFI may provide reference for distinguishing GD from HT with hyperthyroidism

参考文献

[1] 胡天一, 刘戈力, 杨箐岩, 等. 儿童自身免疫性甲状腺疾病120例临床诊治和相关因素分析[J]. 天津医科大学学报, 2009, 15(1):88-91.
[2] 王波, 孟佳慧. 甲状腺自身抗体对Graves病及桥本甲状腺炎诊断的研究[J]. 中国实验诊断学, 2018, 22(2):207-209.
[3] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 甲状腺功能减退症基层诊疗指南(2019年)[J]. 中华全科医师杂志, 2019, 18(11):1022-1028.
[4] 马永红. 甲状腺自身抗体在AITD患者血清中的表达及临床研究[D]. 青海: 青海大学, 2015.
[5] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 甲状腺功能亢进症基层诊疗指南(实践版·2019)[J]. 中华全科医师杂志, 2019, 18(12):1129-1135.
[6] 陈佩宣, 曹思敏, 吴细妹, 等. 东莞市东南片区3-6岁儿童甲状腺功能指标参考范围的建立[J]. 检验医学与临床, 2019, 16(6):828-830,856.
[7] 张久丹, 王燕燕, 陈晔, 等. 儿童自身免疫性甲状腺疾病的诊治[J/CD]. 中华临床医师杂志:电子版, 2013, 7(24):11639-11642.
[8] Lindgren O, Asp P, Sundlov A, et al. The effect of radioiodine treatment on TRAb, anti-TPO, and anti-TG in Graves'disease[J]. Eur Thyroid J, 2019, 8(2):64-69.
[9] Chai H, Zhu ZJ, Chen ZQ, et al. Diagnostic value of Tg and TgAb for metastasis following ablation in patients with differentiated thyroid carcinoma coexistent with Hashimoto thyroiditis[J]. Endocr Res, 2016, 41(3):218-222.
[10] 汤进, 黄晓霞, 孔花娟, 等. TSH、TPOAb、TRAb、TGAb检测在甲状腺疾病临床诊断中的应用研究[J]. 现代医学, 2019, 47(7):847-850.
[11] 孙荷, 胡珊, 骆盛. Anti-TgAb和Anti-TPOAb在自身免疫性甲状腺疾病诊断中的意义[J]. 中国卫生检验杂志, 2010, 20(11):2866-2867.
[12] 李会广, 姚超峰. 血清TpoAb、TGAb在甲状腺疾病患者中的表达意义[J]. 临床医学研究与实践, 2018, 3(27): 106-108.
[13] 李玲, 马杰, 杨楷. 血清TRAB、TGAB、TPO—AB联合检测在自身免疫性甲状腺病中的临床应用[J]. 检验医学, 2016, 31(B09):108.
[14] 马玉琴. 桥本甲状腺毒症与Graves病鉴别诊断的研究[D]. 山东: 山东省医学科学院, 2007.
[15] Andrioli M, Valcavi R. Ultrasound B-flow imaging in the evaluation of thermal ablation of thyroid nodules[J]. Endocrine, 2015, 48(3):1013-1015.
[16] 方建强, 程莉莉, 李维芝. 颈部淋巴结超声对Graves's病与桥本甲状腺炎的鉴别价值[J]. 肿瘤影像学, 2015, 24(4):267-270.
文章导航

/