Clinical Analysis Of TRAb In Patients With Hashimoto's Thyroiditis Accompanying With Hypothyroidism

Objective:To collect clinical datas and to detect serum free triiodothyronine?FT3?,free thyroxine?FT4?,thyrotropin?TSH?,thyroid peroxidase antibody?TPOAb?,thyrotropin receptor antibody?TRAb?,thyroid stimulating antibody?TSAb?and thyroid stimulating blocking antibody?TSBAb?in patients with Hashimoto's thyroiditis?HT?accompaning with hypothyroidism?HT hypothyroidism?.To compare the positive rate and the level of serum TRAb,TSAb and TSBAb in HT hypothyroidism patients.To analyze the factors that affecting the exprssion of serum TSAb and TSBAb in patients with HT hypothyroidism,and to analyze the effects of serum TSBAb in the occurrence and development of HT hypothyroidism to provide help for further exploring the diagnostic and therapeutic value of TSBAb in HT hypothyroidism.Methods:A total of 133 patients with HT hypothyroidism who visited the endocrinology clinic of Linyi People's Hospital from October 2017 to October 2019 were selected as HT hypothyroidism group,and 125 healthy people who were examined in the physical examination center of Linyi People's Hospital during the same period were selected as control group.The clinical datas of all the above-mentioned were collected,including sex,age,the course of disease,daily dose of L-T4.The level of serum FT3,FT4,TSH,TPOAb and TRAb were detected by chemiluminescence method,and the differences between the two groups were compared.Twenty-two patients whose serum TRAb?1.75 IU/L in HT hypothyroidism group were included in HT hypothyroidism TRAb positive group,thirty patients whose serum TRAb?27?1.75 IU/L in HT hypothyroidism group were included as HT hypothyroidism TRAb negative group,and tweenty patients whose serum TRAb?27?1.75 IU/L in control group were included as healthy negative group.Chinese hamster ovary?rhTSHR-CHO?cell expressing recombinant human TSHR biological method was used to detect the levels of serum TSAb and TSBAb in above three groups,the positive rate and levels of serum TSAb and TSBAb in the three groups were compared.Pearson correlation analysis and multiple linear regression analysis were used to analyze the relationship between TSAb,TSBAb and various indexes,ROC curve was drawn to evaluate the value of TSBAb in diagnosing HT hypothyroidism.Results:?1?The positive rate and level of serum TRAb:compared with control group,the positive rate and level of serum TRAB in HT hypothyroidism group were higher,and the differences were statistically significant?c²=14.725,Z=-5.434,P?27?0.05?;?2?The positive rate and level of serum TSAb:compared with HT hypothyroidism TRAb negative group,the positive rate of serum TSAb in HT hypothyroidism TRAb positive group was higher?c²=62.115,P?27?0.05?,there was no significant difference in the level of serum TSAb among the three groups?P?29?0.05?;?3?The positive rate and level of serum TSBAb:compared with healthy negative group,the positive rate and level of serum TSBAb in HT hypothyroidism TRAb positive group were higher?c²=15.273,t=7.767,P?27?0.05?,compared with HT hypothyroidism TRAb negative group,the positive rate and level of serum TSBAb in HT hypothyroidism TRAb positive group were higher?c²=52.000,t=7.056,P?27?0.05?;There was no significant difference in the positive rate and level of serum TSBAb between HT hypothyroidism TRAb negative group and healthy negative group?P?29?0.05?.?4?Pearson correlation analysis:the level of serum TSAb had no obvious correlation with the course of disease,daily dose of L-T4,and the level of serum FT3,FT4,TSH,TPOAb,TRAb TSBAb;the level of serum TSBAb was positively correlated with the course of disease,daily dose of L-T4 and the level of serum TRAb?r=0.323?0.442?0.756,P?27?0.05?,but not with the levels of serum FT3,FT4,TSH,TPOAb and TSAb.?5?Multiple linear regression analysis:the course of disease and the level of serum TRAb were independent factors which can affect the level of serum TSBAb,regression equation YTSBAb=-6.089+2.451Xthe course of HT hypothyroidism+1.689X_TRAb;?6?ROC curve:ROC curve showed that the best critical point for TSBAb to predict HT hypothyroidism was 7.05%,the sensitivity of prediction was 59.6%,and the specificity was 90%.Conclusions:?1?The positive rate of TRAb in HT hypothyroidism patients was16.54%.?2?The positive rate of TSAb and TSBAb in HT hypothyroidism with TRAb positive patients were 13.64%and 54.55%,respectively.TRAb was a functional antibody at this time,suggesting that TRAb should be detected during pregnancy to prevent hyperthyroidism or hypothyroidism in fetus and newborn,there were 40.91%patients with both antibodies negative which showed that TRAb had no biological activity and existed as an immune marker at this time.?3?The level of TSBAb was positive ralated with the course of disease,daily dose of L-T4,and the level of serum TRAb,the course of disease and the level of serum TRAb were independent factors influencing TSBAb.?4?The best critical value of TSBAb to predict HT hypothyroidism was 7.05%,and the sensitivity and specificity were 59.6%and 90%,respectively.