Young E T, Steel N R, Taylor J J, Stephenson A M, Stratton A, Holcombe M, Kendall-Taylor P
Department of Medicine, Ashington Hospital, Newcastle upon Tyne.
Q J Med. 1988 Feb;66(250):175-89.
A prospective study was carried out to determine the factors which influence response to antithyroid drug treatment in Graves' disease and to assess their predictive value. Eleven variables were included in the assessment and were subjected to discriminant analysis, log rank test and "survival" analysis. The patients were observed for a considerable period (mean duration 51 months). Carbimazole (mean total dose 8 g) was given in combination with thyroxine for an average of eight months to 72 patients. Thirty-five patients relapsed and 37 remain in remission. Thyrotrophin binding inhibiting immunoglobulins (TBII) were detectable in 74 per cent of patients at diagnosis and thyroid stimulating antibodies detectable in 70 per cent. At the end of treatment thyrotrophin binding inhibiting immunoglobulins and thyroid stimulating antibodies were present in 36 and 27 per cent of patients respectively. Levels of thyrotrophin binding inhibiting immunoglobulins were significantly higher both before and after treatment in the group who relapsed, but were not of prognostic significance in an individual patient unless the value was extremely high (TBII index greater than 70). The presence of thyroid stimulating antibodies was of no value in predicting outcome. HLA typing confirmed the known association of Graves' disease with HLA B8 and HLA DR3 but neither of these antigens conferred and increased likelihood of relapse. The likelihood of relapse is shown to be directly related to the severity of the disease at the time of diagnosis, as measured by the serum total T3, and to the size of the thyroid gland; it is not affected by age, family history of thyroid disease or ophthalmopathy. The data indicate that antithyroid drug treatment can be expected to induce long-term remission in patients with mild disease (T3 less than 5 nmol/l) and small thyroids; carbimazole at this dose level is inappropriate for patients with severe disease (T3 greater than 9 nmol/) and large goitres.
开展了一项前瞻性研究，以确定影响格雷夫斯病患者抗甲状腺药物治疗反应的因素，并评估这些因素的预测价值。评估中纳入了11个变量，并对其进行判别分析、对数秩检验和“生存”分析。对患者进行了较长时间的观察（平均时长51个月）。72例患者接受了平均8个月的卡比马唑（平均总剂量8克）联合甲状腺素治疗。35例患者复发，37例仍处于缓解期。诊断时，74%的患者可检测到促甲状腺素结合抑制性免疫球蛋白（TBII），70%的患者可检测到甲状腺刺激抗体。治疗结束时，分别有36%和27%的患者存在促甲状腺素结合抑制性免疫球蛋白和甲状腺刺激抗体。复发组患者治疗前后促甲状腺素结合抑制性免疫球蛋白水平均显著较高，但除非该值极高（TBII指数大于70），否则对个体患者无预后意义。甲状腺刺激抗体的存在对预测结局无价值。HLA分型证实了格雷夫斯病与HLA B8和HLA DR3之间已知的关联，但这两种抗原均未增加复发的可能性。复发的可能性与诊断时疾病的严重程度（通过血清总T3测量）和甲状腺大小直接相关；不受年龄、甲状腺疾病家族史或眼病的影响。数据表明，抗甲状腺药物治疗有望使轻症（T3小于5 nmol/l）和甲状腺较小的患者实现长期缓解；该剂量水平的卡比马唑不适用于重症（T3大于9 nmol/l）和甲状腺肿大的患者。
