摘要目的 观察自身免疫性甲状腺疾病(AITD)患者血清Ⅲ型前胶原(PCⅢ)和透明质酸(HA)水平.探讨其临床意义.方法 按甲状腺功能将114例AITD患者分为3组:①Graves病甲状腺功能亢进(简称甲亢)组(38例),②桥本甲状腺炎甲状腺功能低下(简称甲低)组(35例),③桥本甲状腺炎亚临床甲状腺功能低下(简称哑甲低)组(41例),另设40例健康人作为对照组.用免疫化学发光法检测以上各组人群血清游离三碘甲腺原氨酸(FT3),游离甲状腺素(FT4),超敏促甲状腺激素(sTSH)水平.用酶联免疫吸附试验(ELISA)检测血清PCⅢ水平,用放射免疫分析法(RIA)检测血清HA水平.结果 甲亢组血清FT3,FT4水平[(18.35±6.19),(76.28±23.49)pmol/L]明显高于对照组[(4.75±0.31),(16.12±3.27)pmol/L],sTSH水平[(0.15±0.07)mU/L]明显低于对照组[(3.78±0.15)mU/L],差异均有统计学意义(P＜0.01),甲低组FT3,FT4水平[(3.36±0.26),(6.37±2.19)pmol/L]均低于对照组(P＜0.05),sTSH[(44.58±13.29)mU/L]明显高于对照组(P＜0.01),亚甲低组FT3,FT4水平[(4.86±0.45),(15.26±2.78)pmol/L]与对照组比较,差异无统计学意义(P＞0.05),sTSH[(14.26±4.73)mU/L]明显高丁对照组(P＜0.01).甲亢组血清PCⅢ水平[(4.63±1.22)μg/L]明显高于甲低组[(3.64±1.12)μg/L],亚甲低组[(3.54±1.17)μg/L],对照组[(3.56±1.07)μg/L],组问两两比较差异有统计学意义(P＜0.05),而甲低组,哑甲低组,对照组PCⅢ水平任意两组间比较,差异均无统计学意义(P＞0.05),甲低组血清HA水平[(31.13±10.28)μg/L]高于甲亢组[(22.24±7.22)μg/L],亚甲低组[(22.43 4-7.99)μg/L]和对照组[(23.09±9.19)μg/L],组间两两比较差异均有统计学意义(P＜0.05),而甲低组,亚甲低组,对照组HA水平任意两组比较,差异均无统计学意义(P＞0.05).结论 在排除肝纤维化等病变的情况下,检测甲亢患者血清PCⅢ,对了解早期的心肌纤维化有重要意义,对病程较长的甲亢患者,血清HA,PCⅢ的榆测可作为早期发现肝损伤和纤维化的参考依据.

abstractsObecfive To study the clinical significance of detecting serum proeollagen type Ⅲ(PCⅢ) and hyaluronie acid(HA)in patients with autoimmune thyroid diseases(AITD).Methods According to the thyroid function,the 114 patients with AITD were divided into hyperthyroidism group(38),hypothyroidism group(35),and sub-hypothyroidism group(41).In addition,40 healthy persons were served as controls.The level of serum PCⅢ was determined with ELISA and that of serum HA with RIA.The level of FT3,FT4 and sTSH were detected by immumnofluorometric assay.Results Serum FT3(18.35±6.19)pmol/L]and FT4[(76.28±23.49)pmol/L]level of patients with hyperthyroidism were obviously higher than those of the controls[(4.75±0.31),(16.12±3.27) pmol/L],but serum sTSH[(0.15±0.07)mU/L]was obviously lower than that of the control[(3.78±0.15)mU/L],the differences were statically significant(P＜0.01).Serum FT3[(3.36±0.26)pmol/L]and FT4 [(6.37±2.19) pmol/L]level of patients with hypothyroidism were both lower than those of the controls(P＜0.05).but serum sTSH[(44.58±13.29)mU/L]was obviously higher than that of the control(P＜0.01).Serum FT3 [(4.86±0.45)pmol/L]and FT4[(15.26±2.78)pmol/L]level of patients with sub-hypothyroidism had no statistical difference compared with those of the controls(P＞0.05),but serum sTSH[(14.26±4.73)mU/L] was obviously higher than that of the controls(P＜0.01).The level of sernm PCⅢ[(4.63±1.22)μg/L]in pafients with hyperthyroidism was significantly higher than that of any other group(P＜0.05).There waB no statistical significant difference in PCⅢ among the patients with hypothyroidism,the patients with sub-hypothyroidism and controls [(3.64±1.12),(3.54±1.17)and(3.56±1.07)μg/L],respectively(P＞0.05).The level of serum HA [(31.13±10.28)μg/L]in patients with hypothyroidism was significantly higher than that of any other group(P＜0.05).There was no statistical significant difference in HA among the patients with hyperthyroidism,the patients with sub-hypothyroidism and controls[(22.24±7.22),(22.43±7.99)and(23.09±9.19)μg/L,respectively,P＞0.05].Conclusions It is very significant to understand myocardial fibrosis early through detecting sernm PCⅢ in patients with hyperthyroidism.Measurement of serum PCⅢ and HA will be useful to discovery hepatic fibrosisearly in patients with a long course of hyperthyroidism.