Graves病甲状腺自身抗体的临床和免疫印迹研究

Clinical and immunoblotting analysis of thyroid autoantibodies in Graves' disease

目的 研究Graves病 (GD)甲状腺自身抗体的临床特点及异质性。方法 运用放免法测定 77例GD甲亢期、76例GD缓解期患者及 39例正常人的甲状腺球蛋白 (TG)、反三碘甲腺原氨酸 (rT3)、游离三碘甲腺原氨酸 (FT3)、游离甲状腺素 (FT4 )、超敏促甲状腺激素 (s TSH)、甲状腺球蛋白抗体 (TGAb)、甲状腺过氧化物酶抗体 (TPOAb)、TSH受体抗体 (TRAb) ,分析各抗体与临床指标间的关系。同时以正常、GD及桥本甲状腺炎 (HT)甲状腺组织作为抗原 ,运用免疫印迹 (Westernblot)检测GD甲状腺自身抗体 ,并以正常阴性血清及标准阳性血清 (TGAb、TPOAb、TRAb阳性 )作为对照。结果 与缓解期患者相比 ,GD甲亢期患者TRAb水平及阳性率显著增高 (P <0 0 0 1)。GD甲亢期患者的TRAb水平与FT3间存在显著正相关 (r =0 4 2 4 ,P <0 0 5 )。免疫印迹检测发现GD血清可与多种甲状腺抗原反应 ,GD血清在HT及GD甲状腺组织抗原泳道出现的条带数明显多于正常甲状腺组织抗原泳道 ,且有的条带不出现于正常甲状腺组织抗原泳道。GD血清可出现阳性对照血清所不出现的阳性条带。结论 TRAb在GD的致病中起重要作用 。

Objective To study the clinical feature and the heterogeneity of thyroid autoantibodies in Graves disease.Methods Serum TG,rT3,FT3,FT4,s TSH,TGAb,TPOAb and TRAb were determined by radioimmunoassay in 77 patients with Graves disease in hyperthyroidism,76 patients in remission and 39 normal controls.The relation between thyroid antibodies and clinical indexes was analyzed.Using thyroid tissues of normal,Graves disease and Hashimotos thyroiditis as antigen,we detected the thyroid antibodies in Graves disease by Western blot.The sera of normal negative and standard positive (TGAb+,TPOAb+,TRAb+)were used as control.Results Only the titre and positive rate of TRAb in patients with Graves disease in hyperthyroidism were much higher than those in patients in remission.There was positive correlation between the titer of TRAb and titer of FT3 in Graves disease in hyperthyroidism( r= 0 424, P< 0 05).The sera of patients with Graves disease can react with many thyroid antigens in Western blot.The number of bands appearing in electrophoretic lane of tissues of Graves disease and Hashimotos thyroiditis were much more than those in normal thyroid.Some bands didnt appear in electrophoretic lane of tissues of normal thyroid.Conclusions TRAb plays an important role in the pathogenesis of Graves disease.In addition to TGAb,TPOAb and TRAb,there were other thyroid antibodies in Graves disease and there was heterogeneity in thyroid autoantibodies.