血清甲状腺球蛋白抗体在分化型甲状腺癌中的产生机制及其临床价值

The generation mechanism and clinical value of serum thyroglobulin antibody in differentiated thyroid carcinoma

近年来,分化型甲状腺癌(DTC)的发病率呈逐年上升趋势,大多数患者通过外科手术、放射性碘治疗和促甲状腺激素抑制治疗后的预后良好,可获得长期生存,但部分患者存在疾病的持续、复发及转移。甲状腺球蛋白(Tg)作为DTC全切或近全切除术后灵敏、简便的血清学肿瘤标志物,在患者长期随访中的定期监测极为重要。然而,在高达25%的DTC患者的血清中可检测出高水平甲状腺球蛋白抗体(TgAb),其存在会干扰Tg的测定,此时TgAb的变化趋势就成为判断疾病状态的替代指标。TgAb随时间推移呈下降趋势往往预示疾病好转,相反,TgAb持续升高可能是DTC复发的早期指标。笔者主要就TgAb在DTC患者中的产生机制及其与临床的相关性进行综述。

The incidence of differentiated thyroid carcinoma(DTC)has kept increasing over the recent decades,and most patients carry a good prognosis and long-term survival through surgery,radioactive iodine therapy,and thyroid-stimulating hormone suppression therapy,while some patients have persistent,recurrent or metastatic disease.Thyroglobulin(Tg)can be regarded as a sensitive and convenient biochemical tumor marker after total or near-total resection of DTC and radioiodine therapy.Regular monitoring of Tg and thyroglobulin antibody(TgAb)in the long-term follow-up of patients is of extreme importance for disease surveillance.However,high serum levels of TgAb can be detected in up to 25%of patients with DTC,which will interfere with the accuracy of Tg assay.During which,the trends of TgAb can be served as a surrogate indicator to reflect the tumor status.A falling TgAb trend over time often indicates the remission or improvement of the disease.On the contrary,a sustained rising TgAb trend may be an early indicator of recurrence or metastases of DTC.Herein,the authors mainly reviewed the possible mechanism TgAb production and its clinical relevance in DTC.