Evaluation of the Value of FT4/FT3 and Thyroglobulin Combined with Thyroid Hormone Antibodies in the Diagnosis of Subacute Thyroiditis

doi:10.12114/j.issn.1007-9572.2018.00.096

Abstract

Abstract: Objective　To explore the diagnostic value of thyroglobulin（Tg） and free thyroxine/free triiodothyronine（FT4/FT3） combined with thyroid hormone antibodies in the diagnosis of subacute thyroiditis.Methods　Eighty-eight patients with subacute thyroiditis who were admitted to the Second Affiliated Hospital of Henan University of Chinese Medicine between August 2014 and August 2017，and who met the inclusion criteria，were selected as a subacute thyroiditis group.Eighty-two healthy volunteers who received physical examinations in the hospital during the same period were selected as a control group.Sixty-six patients with thyrotoxicosis，such as hyperthyroidism，were selected as another thyroid disease group.Thyroid-related markers in all subjects were tested，including Tg，FT4，FT3，thyroid-stimulating hormone（TSH），thyroglobulin-globin（TgAb），thyroid peroxidase antibody（TPOAb），thyrotropin receptor antibody（TRAb），and thyroid microsomal antibody（TMAb）.The correlations among Tg，FT4/FT3 and TSH，TgAb，TPOAb，TRAb，and TMAb，as well as the factors influencing Tg and FT4/FT3，were analyzed.The value of Tg，FT4/FT3，Tg+FT4/FT3，Tg+TPOAb+TRAb，Tg+TPOAb+TMAb，and Tg+FT4/FT3+TPOAb+TMAb in the diagnosis of subacute thyroiditis was evaluated.Results　Tg was negatively correlated with TgAb and TMAb（P<0.05），and FT4/FT3 was negatively correlated with TSH and TMAb（P<0.05） in the patients with subacute thyroiditis.TgAb and TMAb were factors influencing Tg（P<0.05），and TMAb and TSH were factors influencing FT4/FT3（P<0.05） in the patients with subacute thyroiditis.The AUC of the ROC of Tg in the diagnosis of subacute thyroiditis was 0.756，and the sensitivity and specificity were 76.9% and 95.0%，respectively.The AUC of the ROC of FT4/FT3 in the diagnosis of subacute thyroiditis was 0.698，and the sensitivity and specificity were 78.2% and 84.0%，respectively.The AUC of the ROC of Tg+TPOAb+TMAb in the diagnosis of subacute thyroiditis was 0.841，and the sensitivity and specificity were 94.7% and 89.1%，respectively.Conclusion　Tg and FT4/FT3 alone have limited efficacy in the diagnosis of subacute thyroiditis.Tg，FT4/FT3 combined with TPOAb and TMAb significantly improves the diagnostic efficacy for subacute thyroiditis.

Key words: Thyroiditis, subacute；Thyroglobulin；Thyroxine；Triiodothyronine；Thyroid hormones；Diagnosis

摘要： 目的　探究甲状腺球蛋白（Tg）、游离甲状腺素/游离三碘甲状腺原氨酸（FT4/FT3）联合甲状腺激素抗体诊断亚急性甲状腺炎的价值。方法　选取2014年8月—2017年8月在河南中医药大学第二附属医院住院的符合纳入标准的亚急性甲状腺炎患者88例作为亚甲炎组，选取同期在本院体检的82例健康志愿者为健康对照组，以及在本院就诊的甲状腺功能亢进症等各类甲状腺毒症患者76例为其他组。检测所有研究对象的甲状腺相关指标〔包括Tg、FT4、FT3、促甲状腺激素（TSH）、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）、促甲状腺激素受体抗体（TRAb）、甲状腺微粒体抗体（TMAb）〕，分析亚急性甲状腺炎患者Tg、FT4/FT3与TSH、TgAb、TPOAb、TRAb、TMAb的相关性，Tg、FT4/FT3的影响因素，以及Tg、FT4/FT3、Tg+FT4/FT3、Tg+TPOAb+TRAb、Tg+TPOAb+TMAb、Tg+FT4/FT3+TPOAb+TMAb诊断亚急性甲状腺炎的价值。结果　亚急性甲状腺炎患者Tg与TgAb、TMAb呈负相关（P<0.05）；亚急性甲状腺炎患者FT4/FT3与TSH、TMAb呈负相关（P<0.05）。TgAb、TMAb是亚急性甲状腺炎患者Tg的影响因素（P<0.05）。TMAb、TSH是亚急性甲状腺炎患者FT4/FT3的影响因素（P<0.05）。Tg诊断亚急性甲状腺炎的ROC曲线下面积为0.756，灵敏度及特异度分别为76.9%、95.0%；FT4/FT3诊断亚急性甲状腺炎的ROC曲线下面积为0.698，灵敏度及特异度分别为78.2%、84.0%；Tg+TPOAb+TMAb诊断亚急性甲状腺炎的ROC曲线下面积为0.841，灵敏度及特异度分别为94.7%、89.1%。结论　Tg、FT4/FT3单独诊断亚急性甲状腺炎的效能有限，Tg、FT4/FT3联合TPOAb、TMAb能显著提高对亚急性甲状腺炎的诊断效能。

关键词: 甲状腺炎, 亚急性, 甲状腺球蛋白, 甲状腺素, 三碘甲状腺原氨酸, 甲状腺激素类, 诊断

LU Na,RAN Xiaodan,LI Yongwei, et al. Evaluation of the Value of FT4/FT3 and Thyroglobulin Combined with Thyroid Hormone Antibodies in the Diagnosis of Subacute Thyroiditis　[J]. Chinese General Practice, 2019, 22(3): 361-365. DOI: 10.12114/j.issn.1007-9572.2018.00.096.
路娜,冉晓丹,李永伟等. 甲状腺球蛋白及游离甲状腺素/游离三碘甲状腺原氨酸联合甲状腺激素抗体在亚急性甲状腺炎诊断中的应用价值研究[J]. 中国全科医学, 2019, 22(3): 361-365. DOI: 10.12114/j.issn.1007-9572.2018.00.096.

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