Graves甲亢^131Ⅰ治疗前后血清TRAb动态变化及临床价值

目的通过测定Graves甲亢患者^131Ⅰ治疗前后血清促甲状腺激素受体抗体（TRAb）水平的动态变化，探讨TRAb在^131Ⅰ治疗Graves甲亢中的临床价值。方法回顾性分析我院2008年至2010年12月收治的经^131Ⅰ治疗的Graves甲亢患者，其中有3～18个月完整随访资料者128例，与45名健康对照者分别于^131Ⅰ治疗前及治疗3、6、12和18个月后采用放射受体分析法动态测定其血清TRAb水平的变化，并进行统计学分析。结果45名健康对照者血清TRAb水平为（2．95＋1．48）U／L，128例Graves甲亢患者在^131Ⅰ治疗前血清TRAb水平为（81．52±36．15）U/L，高于健康对照者（拉8．17，P〈0．01）；^131Ⅰ治疗3个月后患者血清TRAb水平[（127．13±49．05）U／L）]明显高于治疗前（拄4．92，P〈0．01）；治疗6个月后患者血清TRAb水平[（59．82±28．51）U／L）]开始降低，与健康对照者比较差异有统计学意义（t=6．89，P〈0．01）；治疗12个月后患者血清TRAb水平[（12．53±9．26）U／L）]明显降低，与健康对照者比较差异有统计学意义（t=2．29，P〈0．01）；治疗18个月后患者血清TRAb水平[（4．29±2．56）U／L）]-9健康对照者比较差异无统计学意义（t=1．53，P〉0．05）。结论动态观察Graves甲亢患者^131Ⅰ治疗前后TRAb水平的变化具有指导治疗、判断疗效、预测复发、鉴别甲状腺功能减退症等重要的临床价值。

Objective To study the changes of serum thyrotrophin receptor antibody (TRAb) in patients of Graves' hyperthyroidism after 131I radiotherapy and explore its clinical significances. Methods A total of 128 patients and 45 nomal controls were included in the study. Serum concentration of TRAb was measured by radioreceptor assay before and at 3, 6, 12 and 18 months after 131I radiotherapy. Results The TRAb level of 45 nomal controls was (2.95 + 1.48) U/L. Abnormally higher TRAb level [( 81.52 +36. 1 5 ) U/L)]was noted in patients before 131J treatment(t=8.17, P＜0.01). The TRAb titer increased further to(127.13±49.05)U/L at 3 months after therapy(t=4.92,P<0.01),before it dropped to (59.82±28.51)U/L and (12.53±9.26)U/L at 6 and 12 months respectively (t=6.89 and t=2.29 ,P＜0.01 ). At 18 months after 131I radiotherapy, the level of TRAb [(4.29+2.56)U/L)]was back to normal with no difference to that of controls(t=1.53,P＞0.05).Conclusion It is of great significance to measure serum concentrations of TRAb after 131I radiotherapy,which is of important clinical value for therapy guidance, efficacy assessment, recurrence prediction and hypothyroidism identification.