Rink T, Holle L H, Schroth H J, Garth H
Abteilung für Nuklearmedizin, Stadtkrankenhaus Hanau, Deutschland.
Nuklearmedizin. 1998 May;37(3):90-4.
This retrospective study is intended to provide further information on the controversially discussed ability of a Thyrotropin Receptor Antibody (TRAb) monitoring for predicting the outcome of Graves' disease.
The study is based on 1480 blood samples of 346 patients (292 female, 54 male; age among 9 and 91 years) suffering from Graves' disease. A comparison between the TRAb levels and the serum free thyroid hormones as well as the basal thyrotropin was performed in the entire collective, in the group of non-treated patients and in 182 individual courses.
Even in comparable states of function, the individual TRAb levels were quite divergent. In the group with persistent dysfunction, they initially varied between 6 and 482 U/l (normal range < 15 U/l). A global evaluation of the particular groups hence did not show any correlation between the functional disorder and the respective TRAb levels. However, when considering the individual courses, a distinct dependence upon the development of the TRAb could be observed. As the limit for separating the group suffering from persistent malfunction or recurrence and the collective in remission, a decline of the individual TRAb level below 50% of the initial value has proven to be most suitable. This was observed in 94% of all remissions. In 90% of all relapsed patients, we either found persistent high TRAb levels (i.e. a maximum decrease down to 50% of the initial value) or another increase of the TRAb levels. The positive and negative predictive values of the method are 97% and 58%, respectively.
The outcome of Graves' disease depends on the individual changes of the TRAb levels rather than on their absolute values. In case of persistent TRAb, you have to expect a continuing dysfunction or a recurrence.
本回顾性研究旨在就促甲状腺素受体抗体（TRAb）监测预测格雷夫斯病结局这一备受争议的能力提供更多信息。
该研究基于346例格雷夫斯病患者（292例女性，54例男性；年龄在9至91岁之间）的1480份血样。在整个群体、未治疗患者组以及182个个体病程中，对TRAb水平与血清游离甲状腺激素以及基础促甲状腺素进行了比较。
即使在功能相当的状态下，个体TRAb水平也存在很大差异。在持续功能障碍组中，其初始值在6至482 U/l之间变化（正常范围<15 U/l）。因此，对特定组别的整体评估未显示功能障碍与各自TRAb水平之间存在任何相关性。然而，考虑个体病程时，可以观察到对TRAb发展的明显依赖性。作为区分持续功能障碍或复发组与缓解群体的界限，个体TRAb水平降至初始值的50%以下已被证明是最合适的。在所有缓解病例中有94%观察到这种情况。在所有复发患者中有90%，我们要么发现TRAb水平持续居高不下（即最大降幅降至初始值的50%），要么发现TRAb水平再次升高。该方法的阳性预测值和阴性预测值分别为97%和58%。
格雷夫斯病的结局取决于TRAb水平的个体变化而非其绝对值。如果TRAb持续存在，则必须预期会持续存在功能障碍或复发。
