促甲状腺激素受体抗体与Graves眼病糖皮质激素治疗敏感性的关系探讨

Study on the association of thyrotropin receptor antibodies with the sensitivity to glucocorticoid therapy in Graves′s ophthalmopathy patients

目的:探讨促甲状腺激素受体抗体(Thyrotropin receptor antibody,TRAb)与Graves眼病(Graves′s ophthalmopa-thy,GO)患者对糖皮质激素治疗敏感性的关系。方法:37例活动性Graves眼病患者给予口服泼尼松治疗,根据治疗后眼病缓解程度及是否仍具活动性评价对激素治疗的敏感性,将病人分为敏感组(S组)和不敏感组(NS组),观察血清TRAb阳性率和抗体水平的变化。结果:敏感组(n=28)治疗前血清TRAb阳性率为76·53%,平均水平为(12·54±5·62)U/L;治疗后TRAb阳性率为22·18%,平均水平为(7·82±4·91)U/L,较治疗前明显下降(P<0·05)。不敏感组(n=9)治疗前血清TRAb阳性率为67·24%,平均水平为(11·07±4·63)U/L,治疗后血清TRAb阳性率为59·74%,平均水平为(10·81±5·96)U/L,与治疗前比较无显著性差异。在治疗前,两组的血清TRAb水平无显著性差异;治疗后,不敏感组的血清TRAb水平明显高于敏感组(P<0·05)。结论:Graves眼病患者血清TRAb水平的变化与糖皮质激素治疗的敏感性密切相关,TRAb可作为评价糖皮质激素治疗效果的主要指标。

Objective：To investigate the association of thyrotropin receptor antibodies （TRAb） with the sensitivity to glucocorticoid therapy in Graves＇s ophthalmopathy（GO） patients. Methods：Total 37 subjects with active GO were treated with prednisone. According to the relieve degree and clinical activity of their eye symptoms post-steroid treatment, patients were grouped into sensitive group（S） and non-sensitive group（NS）. TRAb positive rate and antibody titer of the two groups were compared. Results： In S group （n =28）, the positive rate and titre of TRAb were 76. 53% and （ 12. 54 ±5.62） U/L, respectively; The positive rate and fitre of TRAb post-treatment were 22. 18% and （7.82 ± 4. 91 ） U/L, respectively, were significant lower than data prior treatment. In NS group （n = 9）, the positive rate and titre of TRAb prior treatment were 67.24% and （11.07 ± 4. 63 ） U/L, respectively; The positive rate and titre of TRAb post-treatment were 59. 74% and （10. 81 ±5.96） U/L, there was no significant difference with data prior treatment. Prior treatment, there was no significant difference of TRAb titres between the two groups. Post-treatment, TRAb titres in NS group were significant higher than in S group. Conclusion ：The variations of TRAb level were closely correlated with the sensitivity to glueecorticoid therapy in GO patients.Serum TRAb level can be used as a major index to evaluate therapeutic sensitivity to glucocorticoid therapy in GO.