健康體檢人群甲狀腺抗體與甲狀腺功能相關性分析

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性。 方法 收集2009年1月1日～2013年12月31日北京協和醫院健康醫學部健康體檢者共15 007名資料，女7181名，男7826名，平均年齡為（44.38±11.62）歲，均進行甲狀腺抗過氧化物酶抗體（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。 結果 TPOAb總陽性率為8.97%，女性陽性率高于男性（13.97%比4.38%，P < 0.01），女性陽性率高峰出現在60～<70歲組，為17.09%。TGAb總陽性率為9.58%，女性陽性率高于男性（16.17%比3.54%，P < 0.01），女性陽性率高峰出現在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），較單一抗體陽性者，OR值成倍增長。 結論 免疫機制在甲狀腺功能異常疾病中起到重要作用。甲狀腺自身抗體對甲狀腺具有慢性、潛在的損傷，應重視、加強甲狀腺自身抗體陽性者的隨訪，尤其是雙抗體陽性者，以利于甲狀腺功能異常疾病的預防和臨床早診治期。

[關鍵詞] 甲狀腺抗體；陽性率；甲狀腺功能；成人

[中圖分類號] R581.2 [文獻標識碼] A [文章編號] 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，甲狀腺功能異常疾病發病呈上升趨勢[1]，而自身免疫性甲狀腺疾病（antoimmune thyroid disease，AITD）又是導致甲狀腺功能異常的常見病因，其中橋本病和格雷夫斯病占大多數。血清甲狀腺過氧化物酶抗體（TPOAb）和甲狀腺球蛋白抗體（TGAb）作為自身抗體是AITD中特異性標志物，也日益受到界內的關注。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性率，女性普遍高于男性且表現出種族差異[3]。國內大宗健康人群的甲狀腺抗體報道尚不多見，本文旨在通過回顧性分析大宗健康體檢人群的甲狀腺抗體的陽性檢出率及甲狀腺功能異常疾病的相關性，以期為人群的甲狀腺功能異常疾病的預防檢測和早期診斷提供參考。