血清Irisin、TSH及Hcy在妊娠期甲状腺功能减退症诊断中的应用

doi:10.3877/cma.j.issn.2095-655X.2024.04.010

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摘要目的探讨血清鸢尾素（Irisin）、促甲状腺激素（TSH）及同型半胱氨酸（Hcy）在妊娠期甲状腺功能减退症诊断中的应用价值。方法回顾性分析西安交通大学第一附属医院榆林医院2021年9月至2023年9月收治的100例妊娠期甲状腺功能减退症患者作为甲减组，另选同期体检正常100例孕妇作为对照组，统计两组患者临床资料，并检测两组血清Irisin、TSH及Hcy水平。Pearson相关分析血清Irisin、TSH、Hcy水平及甲状腺功能指标水平的相关性，受试者操作特征（ROC）曲线分析三者对妊娠期甲状腺功能减退症的诊断价值。结果甲减组血清Irisin、TSH、Hcy、甲状腺过氧化物酶抗体（TPO-Ab）水平分别为（7.71±0.84）μg/L、（8.01±1.23）mU/L、（9.89±2.44）μmol/L、（388.45±33.71）U/mL，高于对照组的（4.01±0.92）μg/L、（2.81±0.45）mU/L、（6.82±2.04）μmol/L、（18.56±4.01）U/mL（t=29.70，39.70，9.65，108.96；均P＜0.01）。游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）水平分别为（3.31±0.34）pmol/L、（9.89±1.88）pmol/L，低于对照组（3.92±0.28）pmol/L、（13.04±0.65）pmol/L（t=13.85，15.84；均P＜0.01）。Pearson相关性分析显示：血清Irisin与TSH呈正相关（r=0.411，P＜0.01），与FT3、FT4呈负相关（r=-0.368，-0.391；均P＜0.01），与TPO-Ab无明显相关性（r=0.201，P＞0.05）。血清Hcy与TSH、TPO-Ab呈正相关（r=0.432，0.359；均P＜0.01），与FT3、FT4呈负相关（r=-0.387，-0.374；均P＜0.01）。ROC结果显示，血清Irisin诊断妊娠期甲减的曲线下面积（AUC）为0.755，敏感度、特异度均为76.00%；TSH诊断妊娠期甲减的AUC为0.675，敏感度、特异度分别为64.00%、66.00%；Hcy诊断妊娠期甲减的AUC为0.664，敏感度、特异度分别为60.00%、68.00%；三者联合诊断妊娠期甲减的AUC为0.761，敏感度、特异度分别为71.00%、76.00%。结论妊娠期甲减患者血清Irisin、TSH及Hcy处于高水平状态，且血清Irisin、Hcy均与TSH呈正相关，与FT3、FT4呈负相关。血清Irisin具有较高的诊断效能，三者联合使用可以提升诊断的准确性。

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关键词 ：鸢尾素, 促甲状腺激素, 同型半胱氨酸, 妊娠期, 甲状腺功能减退症

Abstract：ObjectiveTo investigate the application value of serum Irisin, thyroid-stimulating hormone (TSH) and homocysteine (Hcy) in diagnosing gestational hypothyroidism. MethodsFrom September 2021 to September 2023, one hundred cases of hypothyroidism during pregnancy admitted to the First Affiliated Hospital of Xi′an Jiaotong University Yulin Hospital were classified into hypothyroidism group. During the same period, normal physical examinees (100 cases) were classified into control group. Clinical data of the 2 groups were collected, and serum Irisin, TSH and Hcy levels were detected. The correlations among serum Irisin, TSH, Hcy levels and thyroid function indexes were analyzed by Pearson correlation analysis. The diagnostic value of the 3 biomarkers on hypothyroidism in pregnancy was analyzed by receiver operating characteristic (ROC) curve. ResultsThe levels of serum Irisin ［(7.71±0.84)μg/L, (4.01±0.92)μg/L］, TSH［(8.01±1.23)mU/L, (2.81±0.45)mU/L］, Hcy［(9.89±2.44)μmol/L, (6.82±2.04)μmol/L］ and thyroid peroxidase antibody (TPO-Ab) ［(388.45±33.71)U/mL, (18.56±4.01)U/mL］ in hypothyroidism group were higher than those in the control group (t=29.70, 39.70, 9.65, 108.96, all P＜0.01). While the levels of free triiodothyronine (FT3) ［(3.31±0.34)pmol/L, (3.92±0.28)pmol/L］ and free thyroid hormone (FT4) ［(9.89±1.88)pmol/L, (13.04±0.65)pmol/L］ were lower than those in the control group (t=13.85, 15.84, all P＜0.01). Pearson correlation analysis showed that serum Irisin was positively correlated with TSH (r=0.411, P＜0.01), and negatively correlated with FT3 and FT4 (r=-0.368, -0.391, all P＜0.01), but had no significant correlation with TPO-Ab （r=0.201，P＞0.05）. Serum Hcy was positively correlated with TSH and TPO-Ab (r=0.432, 0.359, all P＜0.01), and negatively correlated with FT3 and FT4 (r=-0.387, -0.374, all P＜0.01). ROC results showed that the areas under the curve (AUC) of serum Irisin, TSH and Hcy in diagnosing gestational hypothyroidism were 0.755, 0.675 and 0.664, and the sensitivity and specificity were 76.00%, 64.00%, 60.00%, and 76.00%, 66.00%, 68.00%, respectively. The AUC for the combined diagnosis was 0.761, and the sensitivity and specificity were 71.00% and 76.00%, respectively. ConclusionsSerum Irisin, TSH and Hcy of patients with hypothyroidism during pregnancy are at high levels, and serum Irisin and Hcy are positively correlated with TSH, and negatively correlated with FT3 and FT4. Serum Irisin exhibits high diagnostic efficiency, and the combined use of the 3 biomarkers can enhance the accuracy of diagnosis.

Key words： Irisin Thyroid stimulating hormone Homocysteine Period of pregnancy Hypothyroidism

收稿日期: 2024-07-10

通讯作者: 李妮， Email： lini103582@qq.com

引用本文:

杭中霞王朝霞孙琴李妮. 血清Irisin、TSH及Hcy在妊娠期甲状腺功能减退症诊断中的应用[J]. 中华诊断学电子杂志, 2024, 12(4): 265-269.
Hang Zhongxia, Wang Zhaoxia, Sun Qin, Li Ni.. The application of serum Irisin, TSH and Hcy in diagnosing gestational hypothyroidism. zhzdx, 2024, 12(4): 265-269.

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