Takasu N, Oshiro C, Akamine H, Komiya I, Nagata A, Sato Y, Yoshimura H, Ito K
Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
J Endocrinol Invest. 1997 Sep;20(8):452-61. doi: 10.1007/BF03348001.
TSH receptor antibodies (TRAb) are believed to cause hyperthyroidism of Graves' disease. Thyroid-stimulating antibody (TSAb) and TSH-binding inhibitor immunoglobulin (TBII) have been measured as TRAb to diagnose Graves' disease and to follow Graves' patients. We intended to evaluate the clinical value of TRAb (TSAb and TBII) assay in establishing the diagnosis of Graves' disease and in predicting its clinical course. TSAb and TBII were studied in 686 normal subjects and in 277 Graves' patients before antithyroid drug therapy. We followed serial changes of TSAb and TBII in 30 Graves' patients before, during and after antithyroid drug therapy over 3.5-9 yr. We measured TSAb as a stimulator assay and TBII as a receptor assay. Both TSAb and TBII were distributed normally in 686 normal subjects. ROC curves demonstrated that both TSAb and TBII had high sensitivity and specificity for the diagnosis of Graves' disease, and were equally sensitive and specific; 150% was chosen as cut-off value for TSAb and 10% for TBII. Of the 277 untreated Graves' patients, 254 (92%) had positive TSAb and positive TBII. All of the 277 untreated Graves' patients had positive TRAb (TSAb and/or TBII). We followed the serial changes of TSAb and TBII in 30 Graves' patients over 3.5-9 yr. During antithyroid drug therapy, TSAb and TBII activities decreased and disappeared in 27 patients (Group A), but continued to be high in the other 3 (Group B). The former 27 Group A patients achieved remission, but the latter 3 Group B patients continued to have hyperthyroidism. Of the 27 Group A patients, 16 (59%) had parallel decreases of TSAb and TBII activities; in 6, the changes were predominantly observed in either TSAb or TBII, and in 4, complex changes in TSAb and TBII activities were observed. Disappearance of TSAb and appearance of TSBAb was seen in one. The other 3 Group B patients continued to have high TSAb and TBII activities and to have hyperthyroidism. In conclusion, TSAb and TBII are of clinical value in establishing the diagnosis of Graves' disease and in predicting its clinical course. We clearly demonstrated its diagnostic usefulness. Both TSAb and TBII have high sensitivity and specificity. All of the 277 untreated Graves' patients had TRAb (TSAb and/or TBII). Serial changes of TSAb and TBII during therapy differ from one patient to another, and can be classified into several groups. Changes in TSAb and TBII activities reflect the clinical courses of Graves' patients. The simultaneous measurement of both TSAb and TBII is clinically useful, since TSAb and TBII reflect two different aspects of TRAb. TSAb and TBII are different.
促甲状腺激素受体抗体（TRAb）被认为是导致格雷夫斯病甲亢的原因。甲状腺刺激抗体（TSAb）和促甲状腺激素结合抑制性免疫球蛋白（TBII）已被作为TRAb进行检测，以诊断格雷夫斯病并对格雷夫斯病患者进行随访。我们旨在评估TRAb（TSAb和TBII）检测在格雷夫斯病诊断及预测其临床病程中的临床价值。对686名正常受试者和277名未接受抗甲状腺药物治疗的格雷夫斯病患者进行了TSAb和TBII研究。我们对30名格雷夫斯病患者在抗甲状腺药物治疗前、治疗期间及治疗后3.5至9年期间TSAb和TBII的系列变化进行了跟踪。我们将TSAb作为刺激试验进行检测，将TBII作为受体试验进行检测。TSAb和TBII在686名正常受试者中均呈正态分布。ROC曲线表明，TSAb和TBII对格雷夫斯病的诊断均具有高敏感性和特异性，且敏感性和特异性相当；TSAb的截断值选为150%，TBII的截断值选为10%。在277名未经治疗的格雷夫斯病患者中，254名（92%）TSAb和TBII均为阳性。所有277名未经治疗的格雷夫斯病患者TRAb（TSAb和/或TBII）均为阳性。我们对30名格雷夫斯病患者在3.5至9年期间TSAb和TBII的系列变化进行了跟踪。在抗甲状腺药物治疗期间，27名患者（A组）的TSAb和TBII活性降低并消失，但另外3名患者（B组）的活性持续升高。前27名A组患者病情缓解，但后3名B组患者仍患有甲亢。在27名A组患者中，16名（59%）TSAb和TBII活性平行下降；6名患者中，变化主要见于TSAb或TBII，4名患者中，TSAb和TBII活性出现复杂变化。1名患者出现TSAb消失和TSBAb出现。另外3名B组患者TSAb和TBII活性持续升高且患有甲亢。总之，TSAb和TBII在格雷夫斯病诊断及预测其临床病程中具有临床价值。我们明确证明了其诊断用途。TSAb和TBII均具有高敏感性和特异性。所有277名未经治疗的格雷夫斯病患者均有TRAb（TSAb和/或TBII）。治疗期间TSAb和TBII的系列变化因人而异，可分为几组。TSAb和TBII活性的变化反映了格雷夫斯病患者的临床病程。同时检测TSAb和TBII在临床上是有用的，因为TSAb和TBII反映了TRAb的两个不同方面。TSAb和TBII是不同的。
