第二代TRAK人体检测方法的使用并未改善对格雷夫斯病抗甲状腺药物治疗后复发的预测。

Use of the 2nd generation TRAK human assay did not improve prediction of relapse after antithyroid medical therapy of Graves' disease.

作者信息

Zimmermann-Belsing T, Nygaard B, Rasmussen A K, Feldt-Rasmussen U

机构信息

Department of Endocrinology, Rigshospitale, University of Copenhagen, Denmark.

出版信息

Eur J Endocrinol. 2002 Feb;146(2):173-7. doi: 10.1530/eje.0.1460173.

DOI:10.1530/eje.0.1460173

PMID:11834425

Abstract

OBJECTIVE

Antithyroid drug treatment (ATD) is used world-wide in the treatment of thyrotoxicosis in patients with Graves' disease (GD). The main problem is a relapse rate of 30 to 50% within 2 years after the treatment has stopped. The measurement of thyrotropin receptor antibodies (TRAb) in serum has been used to confirm the diagnosis of GD in selected patients with a diagnostic specificity of 70 to 90%. However, in predicting the recurrence of thyrotoxicosis after discontinuing ATD it has been of little value. The aim of this study was to evaluate the ability of TRAb measured by the more sensitive recombinant human TSH receptor method to predict risk of recurrence of GD after discontinuing ATD. MATERIALS, PATIENTS AND METHODS: One hundred and twenty nine patients with newly diagnosed GD were included. Of these, 58 had relapse of hyperthyroidism in a follow-up of at least 11 months (median 18 months, range 11-49) after discontinuing ATD. In 122 Graves' patients TRAb were measured at the time of diagnosis and in all patients when discontinuing ATD by a competitive radioreceptor assay using recombinant human TSH receptors (TRAK human assay).

RESULTS

We found an increased diagnostic specificity (99%) compared with the old TRAK porcine assay. The predictive values of a positive and negative test in relation to the prediction of a relapse of GD were found to be only 55% and 62% respectively when using a cut-off level of 1.5 IU/l, and the predictive value of a positive test decreased to 49% and of a negative test to 60% at a lower cut-off limit (1 IU/l).

CONCLUSION

Our study confirms that the new TRAK human assay had a superior diagnostic sensitivity in comparison with the old TRAK porcine assay. Despite the higher diagnostic sensitivity of the TRAK human method, we could not find any improvement of predictive values for relapse of hyperthyroidism in the measurement of TRAb at the end of ATD.

摘要

目的

抗甲状腺药物治疗（ATD）在全球范围内用于治疗格雷夫斯病（GD）患者的甲状腺毒症。主要问题是停药后2年内复发率为30%至50%。血清促甲状腺素受体抗体（TRAb）检测已用于确诊部分GD患者，诊断特异性为70%至90%。然而，在预测停用ATD后甲状腺毒症复发方面，其价值不大。本研究的目的是评估采用更敏感的重组人促甲状腺素受体方法检测的TRAb预测停用ATD后GD复发风险的能力。

材料、患者与方法：纳入129例新诊断的GD患者。其中，58例在停用ATD后至少11个月（中位时间18个月，范围11 - 49个月）的随访中出现甲亢复发。122例格雷夫斯病患者在诊断时检测TRAb，所有患者在停用ATD时采用重组人促甲状腺素受体竞争性放射受体测定法（TRAK human测定法）检测TRAb。