放射性碘对格雷夫斯病促甲状腺素受体抗体的长期影响。

Long-term effects of radioiodine on thyrotrophin receptor antibodies in Graves' disease.

作者信息

Aizawa Y, Yoshida K, Kaise N, Kaise K, Fukazawa H, Kiso Y, Mori K, Sayama N, Kikuchi K, Abe K

机构信息

Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.

出版信息

Clin Endocrinol (Oxf). 1995 May;42(5):517-22. doi: 10.1111/j.1365-2265.1995.tb02671.x.

DOI:10.1111/j.1365-2265.1995.tb02671.x

PMID:7621571

Abstract

OBJECTIVE

Graves' disease is recognized as an organ-specific autoimmune disorder caused by the presence of TSH receptor antibodies. The long-term effects of 131I treatment for Graves' disease on TSH receptor antibodies have not previously been studied. We have measured the TSH-binding inhibitory immunoglobulin (TBII) index and thyroid stimulating antibody (TSAb) activity in patients with Graves' disease following treatment with 131I.

DESIGN

A retrospective study.

PATIENTS

Two hundred and twenty-five patients with Graves' disease who were treated with 131I 1-13 years earlier were studied (1 year: 27 patients; 2-5 years: 42 patients; 6-9 years: 79 patients; 10-13 years: 77 patients).

MEASUREMENTS

The TBII index was measured as the percentage 125I-TSH bound to pig thyroid membranes and TSAb activity as the amount of cAMP produced by cultured FRTL-5 cells.

RESULTS

TBII was detected in 78% of patients prior to 131I administration. Following 131I administration, the incidence of positive TBII was 85% at the end of the first year decreasing to 40, 19, and 17% at 2-5, 6-9 and 10-13 years, respectively. The frequency of a positive TSAb was 74% at the end of the first year, and also decreased to 49, 27 and 29% at 2-5, 6-9 and 10-13 years, respectively. At more than 2 years after 131I therapy, the frequencies of hyperthyroidism in TBII and TSAb positive patients were 42% (19/45) and 30% (19/63), respectively, which were significantly higher than those in TBII and TSAb negative patients (8%: 12/153 and 8%:11/131, respectively). The frequency of hyperthyroidism after 131I treatment in patients with negative TBII before treatment (7%:2/29) was significantly lower than that (29%:30/102) in patients with positive TBII before treatment.

CONCLUSIONS

These results indicate that (1) the TBII index and TSAb activity decreased over a period of more than 2 years after 131I therapy for Graves' disease, and (2) the TBII index before treatment may influence the long-term outcome of 131I therapy.

摘要

目的

格雷夫斯病被认为是一种由促甲状腺激素受体抗体引起的器官特异性自身免疫性疾病。此前尚未研究过131I治疗格雷夫斯病对促甲状腺激素受体抗体的长期影响。我们测定了格雷夫斯病患者接受131I治疗后的促甲状腺激素结合抑制性免疫球蛋白（TBII）指数和促甲状腺素刺激抗体（TSAb）活性。

设计

一项回顾性研究。

患者

研究了225例1 - 13年前接受131I治疗的格雷夫斯病患者（1年：27例；2 - 5年：42例；6 - 9年：79例；10 - 13年：77例）。

测量

TBII指数以与猪甲状腺膜结合的125I - TSH的百分比来衡量，TSAb活性以培养的FRTL - 5细胞产生的环磷酸腺苷（cAMP）量来衡量。

结果

在给予131I之前，78%的患者检测到TBII。给予131I后，第一年结束时TBII阳性发生率为85%，在2 - 5年、6 - 9年和10 - 13年分别降至40%、19%和17%。TSAb阳性频率在第一年结束时为74%，在2 - 5年、6 - 9年和10 - 13年也分别降至49%、27%和29%。在131I治疗超过2年后，TBII和TSAb阳性患者的甲亢发生率分别为42%（19/45）和30%（19/63），显著高于TBII和TSAb阴性患者（分别为8%：12/153和8%：11/131）。治疗前TBII阴性患者131I治疗后的甲亢发生率（7%：2/29）显著低于治疗前TBII阳性患者（29%：30/102）。