促甲状腺素受体抗体在格雷夫斯病管理中的预后价值。
The prognostic value of thyroid-stimulating immunoglobulin in the management of Graves' disease.
作者信息
Zhou Yulin, Zhou Mengxi, Qi Yicheng, Wang Weiqing, Chen Xinxin, Wang Shu
机构信息
Shanghai Clinical Center for Endocrine and Metabolic Diseases, Department of Endocrinology, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School Medical School, Shanghai, P.R. China.
Department of Endocrinology, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, 26 Daoqian Road, Suzhou 215000, P.R. China.
出版信息
Ther Adv Endocrinol Metab. 2021 Sep 28;12:20420188211044943. doi: 10.1177/20420188211044943. eCollection 2021.
BACKGROUND
The bioassay of thyroid-stimulating immunoglobulin was reported to have a similar performance to the commonly used thyroid-stimulating hormone binding inhibition assay, also known as thyroid receptor antibody assay. The normal reference range of thyroid receptor antibody levels indicates the withdrawal of anti-thyroid drugs in the recent clinical guidelines.
METHODS
A prospective, longitudinal observational study was conducted to evaluate the prognostic value of thyroid-stimulating immunoglobulin in patients with Graves' disease.
RESULTS
A total of 77 patients with Graves' disease treated with anti-thyroid drugs were in a continuous follow-up until 1 year after anti-thyroid drugs discontinuation. Commercial kits of thyroid-stimulating immunoglobulin and M22-thyroid-stimulating hormone binding inhibition assay were used and compared. Thyroid-stimulating immunoglobulin was all negative in healthy controls, Hashimoto thyroiditis, and subacute thyroiditis. Thyroid-stimulating immunoglobulin value was highest in untreated patients with Graves' disease (< 0.001). Under anti-thyroid drugs treatment, thyroid-stimulating immunoglobulin value decreased gradually. A total of 21 patients had positive thyroid-stimulating immunoglobulin at the end of treatment. According to clinical fate of patients with Graves' disease after withdrawal of anti-thyroid drugs, thyroid-stimulating immunoglobulin value and positivity in patients with relapse were significantly higher than that reported in patients with remission (= 0.001, < 0.001). After adjustment for age, gender, initial thyroid receptor antibody, initial thyroid-stimulating immunoglobulin, and thyroid receptor antibody at the end of treatment, the odds ratio of positive thyroid-stimulating immunoglobulin for the risk of relapse was 33.271 (95% confidence interval: 4.741-233.458, < 0.001) and odds ratio of quantitative thyroid-stimulating immunoglobulin was 1.009 (95% confidence interval: 1.002-1.015, < 0.001).
CONCLUSION
Thyroid-stimulating immunoglobulin is a good predictor of relapse in patients with Graves' disease treated with anti-thyroid drugs. It might be safer to discontinue anti-thyroid drugs when thyroid-stimulating immunoglobulin and thyroid receptor antibody were both negative.
背景
据报道，促甲状腺素免疫球蛋白的生物测定与常用的促甲状腺激素结合抑制测定（也称为甲状腺受体抗体测定）具有相似的性能。甲状腺受体抗体水平的正常参考范围表明在最近的临床指南中停用抗甲状腺药物。
方法
进行了一项前瞻性纵向观察研究，以评估促甲状腺素免疫球蛋白在格雷夫斯病患者中的预后价值。
结果
共有77例接受抗甲状腺药物治疗的格雷夫斯病患者持续随访至停用抗甲状腺药物后1年。使用并比较了促甲状腺素免疫球蛋白和M22-促甲状腺激素结合抑制测定的商业试剂盒。促甲状腺素免疫球蛋白在健康对照、桥本甲状腺炎和亚急性甲状腺炎中均为阴性。未治疗的格雷夫斯病患者促甲状腺素免疫球蛋白值最高（<0.001）。在抗甲状腺药物治疗下，促甲状腺素免疫球蛋白值逐渐下降。共有21例患者在治疗结束时促甲状腺素免疫球蛋白呈阳性。根据停用抗甲状腺药物后格雷夫斯病患者的临床转归，复发患者的促甲状腺素免疫球蛋白值和阳性率显著高于缓解患者（=0.001，<0.001）。在调整年龄、性别、初始甲状腺受体抗体、初始促甲状腺素免疫球蛋白和治疗结束时的甲状腺受体抗体后，促甲状腺素免疫球蛋白阳性对复发风险的比值比为33.271（95%置信区间：4.741-233.458，<0.001），定量促甲状腺素免疫球蛋白的比值比为1.009（95%置信区间：1.002-1.015，<0.001）。
结论
促甲状腺素免疫球蛋白是接受抗甲状腺药物治疗的格雷夫斯病患者复发的良好预测指标。当促甲状腺素免疫球蛋白和甲状腺受体抗体均为阴性时停用抗甲状腺药物可能更安全。
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