利用独特型——抗独特型理论检测Graves病患者血清中异常免疫球蛋白

IDIOTYPE-ANTI-IDIOTYPE THEORY IN THE DETERMINATION OF ABNORMAL IM-MUNOGLOBULIN (aIgG) IN SERA OF PATIENTS WITH GRAVES DISEASE

根据体外放射分析的原理及独特型——抗独特型理论,利用抗TSH抗体作为结合剂,放射性碘标记的金黄色葡萄球菌A蛋白(^(125)I-SPA)作为定量的示踪剂,建立一种新的检测 Graves病(GD)患者血清中的异常免疫球蛋白(aIgG)的方法,进行了有关方法学的初步研究,探索了TSHAb与aIgG反应的最适反应条件,并与以神经节苷脂为结合剂的酶联免疫吸附分析法(ELISA)作了比较.探讨了aIgG与甲状腺刺激性免疫球蛋白(TSI)的关系.结果显示:TSHAb与GD患者血清中aIgG在体外能够发生特异性结合,而与正常人血清中的IgG、系统性红班狼疮(SLE)患者IgG及糖尿病(DM)患者IgG不发生结合反应.在以aIgG指数作为评价指标时,29名正常人血清aIgG指数为1.06±0.17,其正常范围上限为1.39,在以大于1.39作为阳性时,72名不同临床时期GD患者,初发组阳性率为83%(n=24),临床缓解组阳性率为12%(n=25),复发组阳性率为82%(n=23).正常人血清aIgG指数值与GD初发患者及GD复发患者相比,差异具有极显著性(P<0.001).我们认为本法能较好检出该类aIgG,可用于反映GD患者免疫状况,鉴别诊断及预测治疗缓解后复发的有用指标.

According to the theory of in vitro radioassay, using TSHAb as binder and 125I-staphylococcal protein A (125I-SPA) as tracer agent, a new method for detecting the abnormal immunoglobulin (aIgG) in the sera of patients with Graves disease (GD) was reported. In the initial study of the method, the most appropriate interacting conditions of TSHAb with aIgG were explored and compared with ELISA using ganglioside (GLS) as a binder. The relationship between aIgG and thyroid-stimulating imunoglobulin(TSI) was probed into. The results showed that TSHAb could interact specifically with aIgG in vitro; but it could not interact with IgG from sera of normal subjects, systemic lupus erythematosis (SLE) patients and diabetic patients. With aIgG as an evaluating index, the mean value in 29 normal subjects was 1. 06±0. 17. When the sera of 72 patients with GD in different clinical stages were studied, the aIgG index was positive in 83% of untreated GD patients (n = 24), in 12% of GD patients in clinical remission (n = 25) and in 82% of relapsed GD patients (n = 23). Very significant difference was observed between normal subjets and untreated and relapsed patients with GD (P<0. 001).The results suggest that this method can detect the aIgG effectively, reflect immunologi-cal functional states of the GD patients , differentiate between different autoimmune diseases and serve as a useful parameter for predicting the relapse of the GD after the treatment with antithyroid drugs and operation.