Wright-Pascoe R, Smikle M F, Barton E N, James O B
Department of Medicine University of the West Indies Mona, Kingston, Jamaica.
Hum Antibodies. 1999;9(3):161-4.
The clinical usefulness of commercially prepared haemagglutination kits for thyroperoxidase (TPO) antibody and thyroglobulin (TG) antibody was evaluated in 145 consecutive Jamaicans with Graves' disease. Sixty two (43%) of the patients were newly diagnosed, 12 (8%) were in remission and 71 (49%) had relapsed. Sera from 65 (45%) patients were positive for thyroid antibodies. The TPO antibodies were found in 43% (63/145), thyroglobulin antibodies in 12% (17/145) fifteen (10%) patients had both anti-TPO and TG antibodies. Similar prevalences of TPO antibody were found in newly diagnosed patients and those who had relapsed (44% v. 41%) but the prevalence in the patients in remission was significantly higher (75%; X2 = 4.8, P < 0.05). The prevalence of TPO antibody increased significantly with age at onset before age 35 years compared to later onset (56% v. 32%; X2 = 8.09, P < 0.005). The presence of both TPO antibody (64% v. 31%; X2 = 13.1, P < 0.001) and TG antibody (22% v. 6%; X2 = 8.8, P < 0.005) correlated positively with Graves' ophthalmopathy. Neither of the tests was adequately sensitive in detecting GD in Jamaicans but we recommend testing for TPO antibody without TG antibody as a cost-effective approach. The presence and titres of TPO antibody and TG antibody do not correlate with disease activity and are not reliable enough for monitoring antithyroid drug therapy in GD. There is a need for antibody tests which are efficacious in diagnosing and monitoring antithyroid drug therapy in GD, and suitable for use in developing countries.
我们对145例连续的牙买加格雷夫斯病患者评估了市售的甲状腺过氧化物酶（TPO）抗体和甲状腺球蛋白（TG）抗体血凝试剂盒的临床实用性。其中62例（43%）患者为新诊断病例，12例（8%）处于缓解期，71例（49%）复发。65例（45%）患者的血清甲状腺抗体呈阳性。43%（63/145）的患者检测到TPO抗体，12%（17/145）的患者检测到甲状腺球蛋白抗体，15例（10%）患者同时有抗TPO和TG抗体。新诊断患者和复发患者中TPO抗体的患病率相似（44%对41%），但缓解期患者的患病率显著更高（75%；X2 = 4.8，P < 0.05）。与发病较晚相比，35岁之前发病的患者TPO抗体患病率显著增加（56%对32%；X2 = 8.09，P < 0.005）。TPO抗体（64%对31%；X2 = 13.1，P < 0.001）和TG抗体（22%对6%；X2 = 8.8，P < 0.005）的存在均与格雷夫斯眼病呈正相关。这两种检测方法在检测牙买加人患格雷夫斯病方面均不够敏感，但我们建议检测TPO抗体而不检测TG抗体，作为一种经济有效的方法。TPO抗体和TG抗体的存在及滴度与疾病活动度无关，在监测格雷夫斯病的抗甲状腺药物治疗方面不够可靠。需要有能有效诊断和监测格雷夫斯病抗甲状腺药物治疗且适用于发展中国家的抗体检测方法。
