摘要: |
目的:探讨第3代促甲状腺素受体抗体(TRAb)检测方法(Elecsys电化学发光法)对于甲状腺毒血症病因鉴别诊断的价值。
方法:本研究系1项回顾性队列研究,共招募154例未经治疗的甲状腺毒血症,受试者于2016年1月至2018年5月就诊于华山医院内分泌科门诊。分别测定其甲状腺功能,TRAb,甲状腺摄碘率(RAIU)与甲状腺上动脉收缩期峰值流速(STA-PSV)。
结果:在未经治疗的154名甲状腺毒血症受试者中,111名(72.0%)是女性,平均年龄38.42岁,117人(76.0%)被诊断为Graves病(GD)。如TRAb用于甲状腺毒血症的鉴别诊断,其ROC曲线下面积为0.984(95%CI 0.967-1.000),优于甲状腺上动脉流速(STA-PSV,ROC曲线下面积0.903, 95%CI 0.839-0.967)。TRAb的诊断最佳切割点为1.7 U/L,区分GD与破坏性甲状腺炎(DT)的敏感性和特异性分别为94.8%和94.3%。如将TRAb切割点设定为3.6 U/L,其在GD/DT鉴别中的特异性和阳性预测值达到100%。本研究中,共有5例TRAb阴性(<1.7U/L)的GD患者,其甲状腺上动脉流速均明显升高。
结论:第3代TRAb检测(Elecsys)对甲状腺毒症的鉴别诊断具有较高的敏感性和特异性。甲状腺上动脉流速可作为TRAb测定的互补,有助于甲状腺毒血症的病因鉴别。 |
关键词: 第3代TRAb检测 Elecsys电化学发光法 未经治疗的甲状腺毒血症 鉴别诊断 |
DOI:10.12025/j.issn.1008-6358.2021.20201871 |
分类号:R581 |
基金项目:上海市卫生和计划生育委员会研究课题(20154Y0013). |
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Clinical value of the third generation assay for TSH receptor antibody (Elecsys TRAb) for the differential diagnosis of thyrotoxicosis |
Lili Chen, Yifei Yu, Fangfang Zeng, Xiaolong Zhao, Yiming Li, Hong Liu
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Department of Endocrinology, Huashan Hospital Fudan University
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Abstract: |
Objective: To explore the applicability of third generation TSH receptor antibody (TRAb) assay (Elecsys) in clinical differentiation of Graves’ disease (GD) and destructive thyroiditis (DT).
Methods: We retrospectively recruited 154 subjects with untreated thyrotoxicosis, who visited Huashan hospital between January 2016 and May 2018. Thyroid function, TRAb, radioactive iodine uptake (RAIU) and mean peak systolic velocity of superior thyroid artery (STA-PSV) were detected. Receiver operating characteristic (ROC) curves were drawn.
Results: Of the 154 subjects with untreated thyrotoxicosis enrolled, 111 (72.0%) were female, their mean age were 38.42 years. 117 (76.0%) were diagnosed as GD. The area under the ROC curve for TRAb in the differential diagnosis of thyrotoxicosis was 0.984 (95%CI 0.967-1.000), superior to that of STA-PSV (0.903, 95%CI 0.839-0.967). The best cutoff point of TRAb was 1.7U/L, the sensitivity and specificity in distinguishing GD from DT were 94.8% and 94.3% respectively. If TRAb cutoff point was set 3.6 U/L, its specificity and postive predictive value in GD differentiation reached 100%. There are 5 TRAb negative (<1.7U/L) GD cases, all of whom have significantly elevated STA-PSV.
Conclusions: Our study suggests that the 3rd generation TRAb assay (Elecsys) is sensitive and specific in the differential diagnosis of thyrotoxicosis. STA-PSV is complementary to TRAb assay. |
Key words: third generation TRAb assay Elecsys TRAb untreated thyrotoxicosis differentiation |