促甲状腺激素受体抗体滴度动态变化联合甲状腺超声弹性成像对Graves病复发风险的预警价值

doi:10.3969/j.issn.1006-5725.2026.06.011

Abstract

Abstract:

Objective To investigate the predictive value of dynamic changes in thyrotropin receptor antibody （TRAb） titers combined with ultrasound elastography parameters for predicting recurrence risk in Graves' disease （GD）. Methods A total of 306 patients with GD admitted between January 2019 and November 2021 were enrolled. All patients received standard antithyroid drug treatment and were followed up. Dynamic changes in TRAb titers during treatment were monitored and the patients were divided into a continuously decreasing group and a dynamically increasing group based on the trend of change. Ultrasound elastography was used to measure thyroid volume， elasticity score， mean strain value （MEAN）， and blue area percentage （%AREA）. Independent risk factors for GD recurrence were identified via multivariate logistic regression analysis， and the predictive performance of indicators was evaluated using receiver operating characteristic （ROC） curves. Results A total of 14 cases were lost to follow-up， and 292 cases were eventually included to complete follow-up， including 103 cases in the dynamic increase group and 189 cases in the continuous decrease group. TRAb levels diverged significantly between groups starting at 12 months of treatment. The persistent-decrease group maintained a downward trend， remaining low at follow-up termination. In contrast， the dynamic-increase group showed a slow decline， reaching a nadir at 18 months before rising again， with sustained elevation during follow-up. By the end of follow-up， 87 patients （29.79%） experienced recurrence. The recurrence rate was significantly higher in the dynamic-increase group （66.02%， 68/103） than in the persistent-decrease group （10.05%， 19/189； χ² =99.831， P < 0.05）. Multivariate logistic regression identified TRAb titer elevation， elasticity score （3 ? 4）， elevated %AREA， and increased thyroid volume as independent risk factors for recurrence （P < 0.05）. ROC analysis showed area under the curve （AUC） values of 0.823 for TRAb dynamic elevation， 0.652 for elasticity score （3 ? 4）， 0.801 for %AREA elevation， and 0.724 for thyroid volume enlargement. The ultrasound-combined model achieved an AUC of 0.888， while the four-indicator combined model demonstrated the highest predictive accuracy （AUC = 0.913）. Conclusions Dynamic TRAb elevation and ultrasound elastography parameters are independent predictors of GD recurrence. Their combination enhances the accuracy of recurrence risk prediction.

Key words: Graves' disease, thyrotropin receptor antibody, ultrasound elastography, recurrence, predictive model

CLC Number:

R581

Shengli WU,Aixia XIE,Xiaoyan LUO,Yan ZHAO,Fugang WANG, YILIHAMU·TUNIYAZI. The predictive value of dynamic changes of TSHR antibody titer combined with thyroid ultrasound elastography for the recurrence risk of Graves′ disease[J]. The Journal of Practical Medicine, 2026, 42(6): 991-998.

Figures/Tables 7

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References 25

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时间点	持续降低组（n = 197）	动态升高组（n = 109）
治疗前	12.48 ± 4.17	12.63 ± 4.21
治疗6个月	6.73 ± 2.24	7.26 ± 2.41
治疗12个月	3.24 ± 1.03	5.87 ± 1.94
治疗18个月	1.52 ± 0.47	4.35 ± 1.46
停药1个月	1.48 ± 0.48	4.67 ± 1.52
停药6个月	1.38 ± 0.44	5.28 ± 1.65
停药12个月	1.29 ± 0.41	8.73 ± 2.84
停药18个月	1.21 ± 0.35	11.85 ± 3.87
停药24个月	1.15 ± 0.36	13.46 ± 4.39
F值	F_时间 = 3098.439，F_组间 = 540.541，F_交互 = 273.522
P值	P_时间 < 0.001，P_组间 < 0.001，P_交互 < 0.001

项目	复发组（n = 87）	未复发组（n = 205）	χ²/t值	P值
年龄/岁	41.28 ± 8.64	42.73 ± 9.52	1.223	0.222
性别/［例（%）］			0.022	0.883
男	34（39.08）	82（40.00）
女	53（60.92）	123（60.00）
吸烟史/［例（%）］			0.481	0.488
有	21（24.14）	42（20.49）
无	66（75.86）	163（79.51）
家族史/［例（%）］			0.338	0.561
有	10（11.49）	19（9.27）
无	77（88.51）	186（90.73）
病程/月	6.38 ± 2.17	6.24 ± 1.88	0.555	0.579
GO CAS/［例（%）］			1.111	0.292
CAS ≥3分	18（20.69）	32（15.61）
CAS <3分	69（79.31）	173（84.39）
GO分级/［例（%）］			0.971	0.331
轻度	38（43.68）	96（46.83）
中度	34（39.08）	88（42.93）
重度	15（17.24）	21（10.24）
FT3/（pmol/L）	18.92 ± 5.14	15.37 ± 4.28	6.095	< 0.001
FT4/（pmol/L）	37.45 ± 8.63	29.26 ± 7.84	7.919	< 0.001
TSH/（mIU/L）	0.10 ± 0.03	0.12 ± 0.05	1.737	0.084
TPOAb/（IU/mL）	71.36 ± 16.74	62.18 ± 14.23	4.777	< 0.001
TgAb/（IU/mL）	48.72 ± 11.84	46.41 ± 10.67	1.637	0.103
甲状腺体积/cm³	32.47 ± 8.36	26.83 ± 7.14	5.860	< 0.001
血流分级/［例（%）］			2.022	0.155
0级	5（5.75）	16（7.80）
1级	18（20.69）	52（25.37）
2级	42（48.28）	98（47.80）
3级	22（25.29）	39（19.02）
弹性评分/［例（%）］			9.542	0.002
0	6（6.90）	34（16.59）
1	18（20.69）	49（23.90）
2	11（12.64）	45（21.95）
3	30（34.48）	42（20.49）
4	22（25.29）	35（17.07）
MEAN	12.78 ± 4.23	11.84 ± 3.72	1.894	0.059
%AREA/%	39.26 ± 9.48	30.17 ± 8.86	7.851	< 0.001

变量	β	SE	Wald χ²	OR（95%CI）	P值
TRAb滴度动态升高	1.251	0.432	8.386	3.494（1.498 ~8.148）	0.004
弹性评分（3 ~ 4）	1.031	0.424	5.913	2.804（1.221 ~ 6.437）	0.015
FT3	1.117	0.572	3.813	3.056（0.996 ~ 9.376）	0.052
FT4	0.640	0.352	3.306	1.896（0.951 ~ 3.781）	0.070
TPOAb	0.724	0.541	1.791	2.063（0.714 ~ 5.956）	0.182
甲状腺体积	0.879	0.364	5.831	2.408（1.180 ~ 4.916）	0.016
%AREA	1.326	0.503	6.949	3.766（1.405~10.093）	0.009

预测指标	AUC	95%CI	敏感度/%	特异度/%	Youden指数
TRAb滴度动态升高	0.823	0.781 ~ 0.865	76.32	78.44	0.547
弹性评分（3 ~ 4）	0.652	0.598 ~ 0.706	64.22	62.84	0.370
%AREA升高	0.801	0.756 ~ 0.846	73.56	72.92	0.565
甲状腺体积增大	0.724	0.675 ~ 0.773	68.74	69.23	0.479
超声联合	0.888	0.852 ~ 0.924	84.20	83.72	0.679
四指标联合	0.913	0.874 ~ 0.938	86.32	87.46	0.738

The predictive value of dynamic changes of TSHR antibody titer combined with thyroid ultrasound elastography for the recurrence risk of Graves′ disease

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