Chen Wei, Man Na, Li Yu-shu, Shan Zhong-yan, Teng Wei-ping
Endocrinology Department, Endocrinology Institute, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
Zhonghua Nei Ke Za Zhi. 2006 Feb;45(2):95-9.
To investigate the relationship of thyroid autoantibodies including serum thyroid stimulating antibody (TSAb), thyroid stimulation blocking antibody (TSBAb) and iodine intake with the development and prognosis of Graves' hyperthyroidism.
A total of 63 subjects with overt hyperthyroidism were screened out from 3 Chinese rural communities with different iodine intakes at first survey. Serum TSAb, TSBAb, thyrotropin binding inhibitory immunoglobulin (TBII), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were detected. The patients were followed up 2 years later. TSAb and TSBAb were measured with recombinant human thyrotropin receptor (rhTSHR)-Chinese hamster ovary cell (rhTSHR-CHO cell) bioassay.
At the first survey, the prevalences of positive TSAb, TBII and TSBAb were found in 80.9%, 61.7% and 6.4% of the patients with Graves' disease respectively. TSAb and/or TBII were positive in 91.5% of the patients. The consistent rate of TSAb and TBII was 59.6% in the cases. All indexes mentioned above were higher in the patients than in healthy controls. Positive correlations were found between TSAb and TBII (r = 0.407), TSAb and thyroglobulin (r = 0.301), TSAb and thyroid volume (r = 0.317) respectively. The prevalence of positive TSAb (91.7%) in Graves' patients in iodine excessive area are significantly higher than those in iodine mildly deficient area (66.7%). The positive rates and the titers of TBII, TPOAb and TGAb were not different statistically among the patients in the three communities. At follow-up, the patients with Graves' hyperthyroidism were classified into euthyroid group (G1) and hyperthyroid group (G2) according to their outcomes of the disease. The TSAb titers and the thyroid volume in the cases of G1 decreased significantly, whereas the patients with highly positive TPOAb titers in the first survey and the follow-up were hard to become euthyroid and TSAb may be the secondary factor influencing the thyroid as compared with TPOAb.
TSAb is more significant than TBII in diagnosing and predicting the outcomes of Graves' hyperthyroidism. The application of both TSAb and TBII could raise the positive rates of thyrotrophin receptor antibody tests. TSAb, TPOAb titers and thyroid volume were factors influencing the prognosis of Graves' hyperthyroidism.
探讨血清促甲状腺素抗体（TSAb）、甲状腺刺激阻断抗体（TSBAb）等甲状腺自身抗体及碘摄入量与Graves病甲亢发生、发展及预后的关系。
于首次调查时从3个碘摄入量不同的中国农村社区筛选出63例显性甲亢患者，检测血清TSAb、TSBAb、促甲状腺素结合抑制性免疫球蛋白（TBII）、甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TGAb）。2年后对患者进行随访。采用重组人促甲状腺素受体（rhTSHR）-中国仓鼠卵巢细胞（rhTSHR-CHO细胞）生物测定法检测TSAb和TSBAb。
首次调查时，Graves病患者中TSAb、TBII和TSBAb阳性率分别为80.9%、61.7%和6.4%。91.5%的患者TSAb和/或TBII阳性。二者符合率为59.6%。上述各项指标患者组均高于健康对照组。TSAb与TBII（r = 0.407）、TSAb与甲状腺球蛋白（r = 0.301）、TSAb与甲状腺体积（r = 0.317）之间均呈正相关。碘过量地区Graves病患者TSAb阳性率（91.7%）显著高于碘轻度缺乏地区（66.7%）。3个社区患者的TBII、TPOAb和TGAb阳性率及滴度差异无统计学意义。随访时，根据Graves病甲亢患者病情转归分为甲功正常组（G1）和甲亢组（G2）。G1组患者TSAb滴度及甲状腺体积显著下降，而首次调查及随访时TPOAb滴度高的患者难以恢复甲功正常，与TPOAb相比，TSAb可能是影响甲状腺的次要因素。
TSAb在Graves病甲亢诊断及预后判断中较TBII更具意义。联合应用TSAb和TBII可提高促甲状腺素受体抗体检测的阳性率。TSAb、TPOAb滴度及甲状腺体积是影响Graves病甲亢预后的因素。
