温小恒等
[摘要] 目的 分析健康体检人群甲状腺抗体与甲状腺功能相关性。 方法 收集2009年1月1日～2013年12月31日北京协和医院健康医学部健康体检者共15 007名资料，女7181名，男7826名，平均年龄为（44.38±11.62）岁，均进行甲状腺抗过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）、游离三碘甲状腺原氨酸（FT3）、游离四碘甲状腺原氨酸（FT4）、促甲状腺素（TSH）检测。 结果 TPOAb总阳性率为8.97%，女性阳性率高于男性（13.97%比4.38%，P < 0.01），女性阳性率高峰出现在60～<70岁组，为17.09%。TGAb总阳性率为9.58%，女性阳性率高于男性（16.17%比3.54%，P < 0.01），女性阳性率高峰出现在50～<60岁人群，为18.39%。临床甲亢、亚临床甲亢、临床甲减、亚临床甲减亚人群中TPOAb、TGAb均阳性者分别占38.81%、12.32%、57.50%、19.17%，显着高于正常人群的3.44%（均P < 0.01，OR值分别是39.35、4.37、65.75、7.61），较单一抗体阳性者，OR值成倍增长。 结论 免疫机制在甲状腺功能异常疾病中起到重要作用。甲状腺自身抗体对甲状腺具有慢性、潜在的损伤，应重视、加强甲状腺自身抗体阳性者的随访，尤其是双抗体阳性者，以利于甲状腺功能异常疾病的预防和临床早诊治期。
[关键词] 甲状腺抗体；阳性率；甲状腺功能；成人
[中图分类号] R581.2 [文献标识码] A [文章编号] 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
近年来，甲状腺功能异常疾病发病呈上升趋势[1]，而自身免疫性甲状腺疾病（antoimmune thyroid disease，AITD）又是导致甲状腺功能异常的常见病因，其中桥本病和格雷夫斯病占大多数。血清甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TGAb）作为自身抗体是AITD中特异性标志物，也日益受到界内的关注。临床研究显示，TGAb、TPOAb不仅在桥本病和格雷夫斯病中显着升高[2]，而且在正常成人中也有一定的阳性率，女性普遍高于男性且表现出种族差异[3]。国内大宗健康人群的甲状腺抗体报道尚不多见，本文旨在通过回顾性分析大宗健康体检人群的甲状腺抗体的阳性检出率及甲状腺功能异常疾病的相关性，以期为人群的甲状腺功能异常疾病的预防检测和早期诊断提供参考。
