FT4-FT3及血肌酐作为甲状腺毒症病因鉴别指标可行性探究.docVIP

FT4/FT3及血肌酐作为甲状腺毒症病因鉴别指标可行性探究 　【摘要】 　　目的：探讨FT4/FT3鉴别亚急性甲状腺炎与Graves病的临床价值。方法：选择亚急性甲状腺炎30例与Graves病30例患者，通过对FT4/FT3、血肌酐、血沉、甲状腺摄碘率等进行分析，来获得区别亚急性甲状腺炎与Graves病的有效指标及相应切点值。结果：除FT4在两组间差异无统计学意义外（P ＞0.05），FT3、FT4/FT3、血肌酐、血沉、甲状腺摄碘率两组间差异均有统计学意义（P＜0.05）。以FT4/FT3值≥2.8作为区别亚急性甲状腺炎与Graves病的切点时，灵敏度为83.30%、特异度为76.67%。以SCr≥60 μmol/L来诊断亚急性甲状腺炎与Graves病时，灵敏度为63.33%、特异度为73.33%。结论：FT4/FT3是区别亚急性甲状腺炎与Graves病的有效指标，对于甲状腺毒症患者当FT4/FT3≥2.8时，要考虑亚急性甲状腺炎可能。血肌酐对于鉴别两者也有一定的价值。 【关键词】 亚急性甲状腺炎 Graves病 甲状腺毒症 FT4/FT3 血肌酐 　　[Abstract] Objective： To make a distinction between subacute thyroiditis and Graves’ disease with some simple and pratical parameters. Methods： 30 patients with subacute thyroiditis and 30 with Graves’ disease were studied. Through analysis of FT4/FT3 ratio, serum creatinine(SCr), erythrocyte sedimentation rate(ESR) and radioactive iodine uptake (RAIU), the valuable parameters and the relevant cutoff values to differentiate subacute thyroiditis from Graves’ disease were got. Results： FT3, FT4/FT3 ratio, SCr, ESR and RAIU were significantly different between subacute thyroiditis and Graves’ disease（P＜0.05), FT4 no significantly different between the two groups（P ＞0.05). The cutoff values of FT4/FT3 ratio and of subacute thyroiditis and Graves’ disease were 2.8 and 60 μmol/L respectively. The sensitivity and specificity of the former were 83.30% and 76.67%, the latter 63.33% and 73.33%. Conclusion： FT4/FT3 ratio and SCr are valuable parameters to differentiate subacute thyroiditis from Graves’ disease. To patients with thyrotoxicosis, subacute thyroiditis must be considered when FT4/FT3 ratio is over 2.8. SCr is a relatively valuable parameter to differentiate the two diseases. 　　[Key words] Subacute thyroiditis; Graves’ disease; Thyrotoxicosis; FT4/FT3 ratio; Serum creatinine 　　血循环中过多的甲状腺激素导致的一组临床综合征称为甲状腺毒症，根据发病机制又可分为甲状腺功能亢进类型和非甲状腺功能亢进类型，前者常见疾病为Graves病，而后者常见于亚急性甲状腺炎。亚急性甲状腺炎是临床常见的甲状腺疾病，临床发病率4.9/10万，占甲状腺疾病的5%，临床表现多样，极易误诊[1]。近年来，随着核医学技术在临床的广泛开展，发现非典型亚急性甲状腺炎的病例也越来越多。甲状腺摄碘率检查是诊断亚急性甲状腺炎的可靠方法，但该检查