摘要
目的
探讨检测血清甲状腺刺激性抗体（TSAb）、甲状腺刺激阻断性抗体（TSBAb）对儿童Graves病（GD）、桥本甲状腺炎（HT）的意义。
方法
收集180例自身免疫甲状腺病（AITD）患儿的血清527份，分为GD组282份和HT组245份；甲状腺功能亢进（甲亢）组157份，缓解组279份，甲状腺功能减低（甲减）组91份；GD甲亢组127份和GD缓解组155份；HT甲亢组30份，HT缓解组124份，HT甲减组91份。选择79例同龄健康儿童作为健康对照组。分别用人血清TSAb和TSBAb ELISA试剂盒检测AITD患儿血清TSAb、TSBAb水平，采用化学发光法检测血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）水平，比较各组间TSAb、TSBAb的差异并分析TSAb、TSBAb与FT3、FT4、TSH的相关性。
结果
1.TSAb水平：GD组（0.727±0.157）〉HT组（0.605±0.148）〉健康对照组（0.350±0.105），差异有统计学意义（F＝11.995，P＝0.000）；甲亢组（0.745±0.169）〉缓解组（0.647±0.153）〉甲减组（0.612±0.144）〉健康对照组（0.350±0.105），差异有统计学意义（F＝122.770，P＝0.000）；GD甲亢组（0.747±0.170）〉GD缓解组（0.640±0.160）〉健康对照组（0.350±0.105），差异有统计学意义（F＝156.712，P＝0.000）；HT甲亢组（0.739±0.140）〉HT缓解组（0.655±0.135）〉HT甲减组（0.612±0.140）〉健康对照组（0.350±0.105），差异有统计学意义（F＝109.165，P＝0.000）。2.TSBAb水平：HT组（0.704±0.633）〉GD组（0.567±0.178）〉健康对照组（0.334±0.104），差异有统计学意义（F＝15.610，P＝0.000）；甲减组（0.693±0.125）〉缓解组（0.648±0.446）〉甲亢组（0.562±0.181）〉健康对照组（0.334±0.104），差异有统计学意义（F＝13.311，P＝0.000）；GD缓解组（0.672±0.572）〉GD甲亢组（0.550±0.187）〉健康对照组（0.334±0.104），差异有统计学意义（F＝19.269，P＝0.000）；HT甲减组（0.693±0.725）高于HT甲亢组（0.618±0.142）和HT缓解组（0.619±0.199），且均高于健康对照组（0.334±0.104）；HT甲亢组（0.618±0.142）与HT缓解组（0.619±0.199）比较差异无统计学意义（F＝12.208，P＝0.00）。3.TSAb与TSBAb、FT3、FT4均呈正相关（r＝0.162、0.091、0.194，P均〈0.05），与TSH呈负相关（r＝－0.224，P〈0.05）。TSBAb与FT3呈负相关（r＝－0.155，P〈0.05），与TSH呈正相关（r＝0.131，P〈0.05）。
结论
AITD患儿甲状腺功能的变化与血清TSAb、TSBAb水平有关，TSAb、TSBAb对AITD患儿治疗过程中病情变化有预测作用。
Objective To study the significance of thyroid stimulating antibody （TSAb） and thyroid stimula- ting - blocking antibody （TSBAb） in children with Graves＇ disease （ GD ） or Hashimoto＇s thyroiditis （HT）. Methods Five hundred and twenty - seven eases of serum from 180 children with autoimmune thyroid disease （ AITD ） children were divided into 282 cases of GD and 245 cases of HT. According to the status of thyroid function, they were divided into 157 cases of hyperthyroidism,91 cases of hypothyroidism and 279 cases of normal thyroid. GD group was subdivi- ded into 127 GD hyperthyroidism and 155 GD remission;HT group was subdivided 30 HT hyperthyroidism, 124 HT re- mission and 91 HT hypothyroidism. Seventy - nine healthy children were taken as the healthy control group. Free triiodothyronine （F＇I3）, free thyroxine（ FF4 ） and sensitive thyroid stimulating hormone（TSH） were detected by chemo- Serum TSAb and TSBAb were detected by serum TSAb or TSBAb enzyme linked immunosorbent assay （ ELISA）, respectively. The differences in TSAb and TSBAb among each group were compared and analyzed of find out the relationship between TSAb and TSBAb was performed. Beside, the correlation between TSAb and TSBAb with FT3, FT4, and TSH were analyzed. Results （ 1 ） TSAb levels were significant （ F = 11. 995, all P = 0. 000） ： the GD group （0. 727 ± 0. 157 ） 〉 HT group （0. 605 ± 0. 148 ） 〉 healthy control group （0. 350± 0. 105 ） ; the difference was signifi- cant（ F = 109. 165, P = 0. 000） among hyperthyroidism group （0. 745 ± 0. 169 ） 〉 normal thyroid group （0. 647 ± 0. 153 ） 〉 hypothyroidism group（0. 612 ± 0. 144） 〉 healthy control group （0.350 ± 0. 105 ） ;the difference was signifi- cant（ F = 156. 712, P = 0. 000） in the GD hyperthyroidism group （0. 747± 0. 17 ） 〉 GD remission group （ 0. 640 ± 0. 16） 〉 healthy control group （0. 350 ±0. 105 ） ; the difference was significant （F = 109. 165, P = 0. 000） in the HThyperthyroidism group（0.739 ±0. 140） 〉 HT remission group（0. 655 ±0. 135 ） 〉 HT hypothyroidism group（0.612 ±0. 140） 〉healthy control group （0. 350 ＋0. 105）. （2） TSBAb levels were significantly different （F = 15. 610,P = 0. 000） ： the HT group （0.704 ±0.633 ） 〉 GD group （0.567 ± 0. 178 ） 〉 healthy control group （ 0. 334 ± 0. 104） ; the difference was significant（F = 13. 311, P = 0. 000） in the hypothyroidism group（0. 693± 0. 125 ） 〉 remission group （0. 648 ± 0.446） 〉 hyperthyroidism group （0. 562 ± 0.181 ） 〉 healthy control group （0. 334 ± 0. 104 ） ; the difference was significant（F = 19. 269,P =0. 000） in the GD remission group （0. 672 ±0. 572） 〉 GD hyperthyroidism group （0. 550 ±0. 187） 〉 healthy control group（0. 334 ±0. 104） ;HT hypothyroidism group（0. 693±0. 725） was higher than HT hyperthyroidism group（0.618 ±0. 142） and HT remission group （0.619 ±0. 199） ,the difference was not sig- nificant between HT hyperthyroidism group and HT remission group （ F = 12.208, P = 0.000）. （ 3 ） TSAb level was posi- tively correlated with TSBAb, FI3 and FT4 （ r =- 0. 162,0. 091,0. 194, all P 〈 0.05 ） and was negatively correlated with TSH（ r = - 0.224 ,P 〈 0.05 ）. TSBAb levels were negatively correlated with FI3 （ r = - 0. 155, P 〈 0. 05 ） and was positively correlated with TSH（ r = 0.131 ,P 〈 0.05 ）. Conclusions Thyroid function was related to the serum levels of TSAb and TSBAb. TSAb and TSBAb could be regarded as an important predictive index for children with AITD during the treatment period.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2016年第8期600-603,共4页
Chinese Journal of Applied Clinical Pediatrics
