健康體檢人群甲狀腺抗體與甲狀腺功能相關(guān)性分析

溫小恒等

[摘要] 目的 分析健康體檢人群甲狀腺抗體與甲狀腺功能相關(guān)性。 方法 收集2009年1月1日～2013年12月31日北京協(xié)和醫(yī)院健康醫(yī)學(xué)部健康體檢者共15 007名資料，女7181名，男7826名，平均年齡為（44.38±11.62）歲，均進(jìn)行甲狀腺抗過(guò)氧化物酶抗體（TPOAb）、甲狀腺球蛋白抗體（TGAb）、游離三碘甲狀腺原氨酸（FT3）、游離四碘甲狀腺原氨酸（FT4）、促甲狀腺素（TSH）檢測(cè)。 結(jié)果 TPOAb總陽(yáng)性率為8.97%，女性陽(yáng)性率高于男性（13.97%比4.38%，P < 0.01），女性陽(yáng)性率高峰出現(xiàn)在60～<70歲組，為17.09%。TGAb總陽(yáng)性率為9.58%，女性陽(yáng)性率高于男性（16.17%比3.54%，P < 0.01），女性陽(yáng)性率高峰出現(xiàn)在50～<60歲人群，為18.39%。臨床甲亢、亞臨床甲亢、臨床甲減、亞臨床甲減亞人群中TPOAb、TGAb均陽(yáng)性者分別占38.81%、12.32%、57.50%、19.17%，顯著高于正常人群的3.44%（均P < 0.01，OR值分別是39.35、4.37、65.75、7.61），較單一抗體陽(yáng)性者，OR值成倍增長(zhǎng)。 結(jié)論 免疫機(jī)制在甲狀腺功能異常疾病中起到重要作用。甲狀腺自身抗體對(duì)甲狀腺具有慢性、潛在的損傷，應(yīng)重視、加強(qiáng)甲狀腺自身抗體陽(yáng)性者的隨訪(fǎng)，尤其是雙抗體陽(yáng)性者，以利于甲狀腺功能異常疾病的預(yù)防和臨床早診治期。

[關(guān)鍵詞] 甲狀腺抗體；陽(yáng)性率；甲狀腺功能；成人

[中圖分類(lèi)號(hào)] R581.2 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2015）09（a）-0069-05

[Abstract] Objective To analyze the relationship between thyroid antibodies and thyroid disfunction diseases in checkup people. Methods A total of 15 007 cases of checkup adults were recruited between January 1 2009 to December 31 2013 from Health Checkup Department， Peking Union Medical College Hospital Chinese Academy of Medical Sciences. There were 7826 cases of male， 7181 cases of female， mean age of （44.38±11.62） years old. Serum TPOAb， TGAb， TSH， free T3， free T4 were detected. Results The total positive rate of TPOAb was 8.97%， its positive rate in females was significantly higher than that in males （13.97% vs 4.38%，P < 0.01）， its peak rate in 60-<70 age group， which was 17.09%. The total positive rate of TGAb was 9.58%， its positive rate in females was significantly higher than that in males （16.17% vs 3.54%，P < 0.01）， its peak rate in 50-<60 age group， which was 18.39%. In the clinical hyperthyroid， subclinical hyperthyroid， clinical hypothyroid and subclinical hypothyroid four subgroups， the positive rate of TPOAb and TGAb both were 38.81%， 12.32%， 57.50% and 19.17%， significantly higher than those in non-thyroid dysfunction disease group， which was 3.44% （ all P < 0.01，OR=39.35， 4.37， 65.75 and 7.61 respectively）. Other than single antibody positive group， OR was doubled. Conclusion Immune mechanism plays an important role in the thyroid dysfunction diseases. The chronic and potential damage occur when the thyroid antibody appeared. So it is essential to follow-up these people， especially in both antibodies positive， in order to facilitate prevention， early diagnosis and treatment of thyroid dysfunction diseases.

[Key words] Thyroid antibody； Positive rate； Thyroid function； Adult

近年來(lái)，甲狀腺功能異常疾病發(fā)病呈上升趨勢(shì)[1]，而自身免疫性甲狀腺疾病（antoimmune thyroid disease，AITD）又是導(dǎo)致甲狀腺功能異常的常見(jiàn)病因，其中橋本病和格雷夫斯病占大多數(shù)。血清甲狀腺過(guò)氧化物酶抗體（TPOAb）和甲狀腺球蛋白抗體（TGAb）作為自身抗體是AITD中特異性標(biāo)志物，也日益受到界內(nèi)的關(guān)注。臨床研究顯示，TGAb、TPOAb不僅在橋本病和格雷夫斯病中顯著升高[2]，而且在正常成人中也有一定的陽(yáng)性率，女性普遍高于男性且表現(xiàn)出種族差異[3]。國(guó)內(nèi)大宗健康人群的甲狀腺抗體報(bào)道尚不多見(jiàn)，本文旨在通過(guò)回顧性分析大宗健康體檢人群的甲狀腺抗體的陽(yáng)性檢出率及甲狀腺功能異常疾病的相關(guān)性，以期為人群的甲狀腺功能異常疾病的預(yù)防檢測(cè)和早期診斷提供參考。