The relationship between Metrnl,S-endoglin and thyroid hormones and recurrence after ATD treatment in patients with primary Graves'disease
Objective To investigate the relationship between serum meteorin-like protein(Metrnl),soluble-endoglin(S-endoglin)and thyroid hormones and the recurrence after antithyroid drugs(ATD)treatment in patients with primary Graves'disease(GD).Methods A total of 135 patients with primary GD who were admitted to the Zhangjiagang Traditional Chinese Medicine Hospital from January to December 2018 were selected as GD group.Another 100 healthy volunteers who were underwent physical examinations in our hospital during the same period were selected as control group.The serum Metrnl,S-endoglin levels and thyroid hormones indicators[thyroid stimulating hormone(TSH),free thyroxine(FT4),free triiodothyronine(FT3)and thyrotropin receptor antibody(TRAb)]levels were detected.All patients with primary GD were treated with ATD.Followed up for 2 years after discontinuation of medication,the patient's recurrence status was observed;they were then divided into recurrence group(n=70)and non-recurrence group(n=65)based on whether there was recurrence,and the serum Metrnl,S-endoglin levels and thyroid hormones indicators levels between recurrence group and non-recurrence group were compared.The correlation between serum Metrnl,S-endoglin and TSH,FT4,FT3,TRAb levels was tested by Pearson method.The general data in patients with GD were collected,and the influencing factors of recurrence after treatment with ATD in patients with GD were analyzed by univariate and multivariate logistic regression analysis.Results The serum Metrnl and TSH levels in GD group were significantly lower than those in control group;and the serum S-endoglin,FT4,FT3 and TRAb levels were significantly higher than those in control group(t=24.511,23.642,16.901,21.902,23.855,17.903;all P＜0.05).Pearson correlation analysis showed that the serum Metrnl level was positively correlated with TSH level(r=0.679,P＜0.05),and negatively correlated with FT4,FT3 and TRAb(r=-0.669,-0.710,-0.626;all P＜0.05).The serum S-endoglin level was negatively correlated with TSH level(r=-0.515,P＜0.05),and positively correlated with FT4,FT3 and TRAb(r=0.488,0.523,0.524;all P＜0.05).The serum Metrnl and TSH levels in recurrence group were lower than those in non-recurrence group;and the serum S-endoglin,FT4,FT3 and TRAb levels in recurrence group were significantly higher than those in non-recurrence group(t=8.852,9.044,6.474,3.166,4.347,3.893;all P＜0.05).The gender,age,onset season,family history of hyperthyroidism,history of goitre disease,history of smoking,maintenance time of low-dose drugs and GD severity in two groups were compared,and the difference was not statistically significant(all P＞0.05).Multivariate logistic regression analysis showed that low serum Metrnl and TSH levels,as well as high serum S-endoglin,FT4,FT3 and TRAb levels were risk factors for recurrence in patients with GD after discontinuation of medication(all P＜0.05).Conclusion The serum Metrnl level decreased and S-endoglin level increased in patients with primary GD,which could lead to abnormal expression of thyroid hormones,and both were risk factors for recurrence after treatment with ATD.
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