Wall Jack R, Lahooti Hooshang, El Kochairi Ilhem, Lytton Simon D, Champion Bernard
Department of Medicine, the University of Sydney, Penrith, NSW, Australia.
SeraDiaLogistics, Munich, Germany.
Clin Ophthalmol. 2014 Oct 9;8:2071-6. doi: 10.2147/OPTH.S67098. eCollection 2014.
Although ophthalmopathy is mainly associated with Graves' hyperthyroidism, milder eye changes are also found in about 25% of patients with Hashimoto's thyroiditis (HT). The recent finding of negative thyrotropin receptor (TSHR) antibodies, as measured in the Thyretain™ thyroid-stimulating immunoglobulin (TSI) reporter bioassay, in patients with euthyroid Graves' disease raises the possibility that TSHR antibodies are not the cause of ophthalmopathy in all situations. Here, we have tested serum from patients with HT with and without ophthalmopathy or isolated upper eyelid retraction (UER) for TSHR antibodies, using the TSI reporter bioassay and collagen XIII as a marker of autoimmunity against the orbital fibroblast. Study groups were 23 patients with HT with ophthalmopathy, isolated UER, or both eye features and 17 patients without eye signs. Thyretain™ TSI results were expressed as a percentage of the sample-to-reference ratio, with a positive test being taken as a sample-to-reference ratio of more than 140%. Serum collagen XIII antibodies were measured in standard enzyme-linked immunosorbent assay. TSI tests were positive in 22% of patients with HT with no eye signs but in no patient with eye signs. In contrast, TSI tests were positive in 94% of patients with Graves' ophthalmopathy. Tests were negative in all normal subjects tested. Collagen XIII antibodies were detected in 83% of patients with ophthalmopathy, UER, or both eye features, but in only 30% of patients with no eye signs. Our findings suggest that TSHR antibodies do not play a major role in the pathogenesis of ophthalmopathy or isolated UER in patients with HT. Moreover, the role of TSHR antibodies in the development of ophthalmopathy in patients with Graves' disease remains to be proven. In contrast, collagen XIII antibodies appear to be a good marker of eye disease in patients with HT.
虽然眼病主要与格雷夫斯甲状腺功能亢进症相关，但在约25%的桥本甲状腺炎（HT）患者中也发现了较轻微的眼部变化。在甲状腺功能正常的格雷夫斯病患者中，近期通过Thyretain™促甲状腺素受体（TSHR）抗体检测（在促甲状腺素受体抗体（TSI）报告基因生物测定中测量）发现，TSHR抗体并非在所有情况下都是眼病的病因。在此，我们使用TSI报告基因生物测定法，并以胶原蛋白XIII作为针对眼眶成纤维细胞自身免疫的标志物，检测了患有或未患有眼病或单纯上睑退缩（UER）的HT患者血清中的TSHR抗体。研究组包括23例患有眼病、单纯UER或两者兼具眼部特征的HT患者以及17例无眼部体征的患者。Thyretain™ TSI结果以样本与参考比值的百分比表示，阳性检测定义为样本与参考比值超过140%。血清胶原蛋白XIII抗体通过标准酶联免疫吸附测定法进行测量。无眼部体征的HT患者中22%的TSI检测呈阳性，但有眼部体征的患者中无一例阳性。相比之下，格雷夫斯眼病患者中94%的TSI检测呈阳性。所有检测的正常受试者检测结果均为阴性。83%患有眼病、UER或两者兼具眼部特征的患者检测到胶原蛋白XIII抗体，但无眼部体征的患者中只有30%检测到。我们的研究结果表明，TSHR抗体在HT患者眼病或单纯UER的发病机制中不起主要作用。此外，TSHR抗体在格雷夫斯病患者眼病发展中的作用仍有待证实。相比之下，胶原蛋白XIII抗体似乎是HT患者眼部疾病的良好标志物。
