TRAb在Graves病诊治中的变化及与甲状腺功能、用药剂量及时间的相关性  

Change in TRAb during Diagnosis and Treatment of Graves′ Disease and Its Correlation between TRAb and Thyroid Function,Medication Dosage and Time

作　　者：刘晓相 刘玉盒 高晓燕 陈慧[1] LIU Xiaoxiang;LIU Yuhe;GAO Xiaoyan;CHEN Hui(Department of Endocrinology,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院内分泌代谢科,兰州730030

出　　处：《医学综述》2020年第7期1434-1438,共5页Medical Recapitulate

摘　　要：目的观察新诊断的Graves病患者接受抗甲状腺药物治疗过程中血清促甲状腺激素受体抗体(TRAb)滴度及阳性率的变化及TRAb滴度与甲状腺功能、药物剂量、治疗时间的相关性。方法选择2016年12月至2018年8月兰州大学第二医院收治的32例Graves病患者为研究对象,均给予甲巯咪唑(MMI)治疗,将其治疗过程分为初治期、减药期和维持期三期,检测血清甲状腺功能[促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT 3)、游离甲状腺素(FT 4)]及TRAb,观察药物治疗前后TRAb阳性率及滴度的变化,分析治疗过程中TRAb滴度与甲状腺功能、药物剂量、治疗时间的相关性。结果新诊断的32例Graves病患者在接受MMI治疗过程中TRAb阳性率在初治期、减药期、维持期分别为84.3%(27/32)、75.0%(24/32)、65.6%(21/32)。血清TRAb滴度在初治期、减药期、维持期分别为7.73(2.74,15.28)IU/L、5.08(1.49,9.21)IU/L、2.27(1.26,5.75)IU/L,不同时期比较差异有统计学意义(P<0.05)。血清TRAb滴度在药物治疗过程中与TSH、FT 3、FT 4无相关性(P>0.05),在初治期与药物剂量呈低度正相关(r=0.363,P=0.041),与治疗时间无相关性(P>0.05),在减药期与药物剂量及治疗时间均呈显著正相关(r=0.679,P=0.001;r=0.640,P=0.001)。结论新诊断的Graves病患者TRAb阳性率明显升高,随着患者接受MMI治疗时间的推移,TRAb滴度呈下降趋势。治疗初期及减药过程中,TRAb滴度越高,所需治疗时间可能越长,用药剂量可能越大。患者血清TRAb滴度与甲状腺功能之间并无明确的相关性。Objective To observe the changes of serum thyrotropin receptor antibody(TRAb)titer and positive rate in newly diagnosed Graves′disease patients receiving antithyroid drug and analyze the correlation between TRAb titer and drug dosage,duration of treatment and thyroid function in the course of antithyroid drug treatment.Methods Thirty-two patients with Graves′disease diagnosed at the Second Hospital of Lanzhou University from Dec.2016 to Aug.2018 were included in the research.All the patients were treated with methimazole(MMI).The treatment process was divided into three phases:the initial treatment period,the drug dose reduction period and the drug dose maintenance period.Serum thyroid function indicators[thyroid stimulating hormone(TSH),free triiodothyronine(FT 3),free thyroxine(FT 4)]and TRAb were tested.The changes of TRAb titer and positive rate before and after drug treatment were observed,and the correlations between TRAb titer and thyroid function,drug dosage,duration of treatment were analyzed.Results In the 32 newly diagnosed patients with Graves′disease,the TRAb positive rate during MMI treatment was 84.3%(27/32),75.0%(24/32)and 65.6%(21/32)in the initial treatment period,the drug reduction period,and the maintenance period,respectively.The serum TRAb titers was 7.73(2.74,15.28)IU/L in the initial treatment period,5.08(1.49,9.21)IU/L in the drug reduction period,and 2.27(1.26,5.75)IU/L in the maintenance period,differences between different periods were statistically significant(P<0.05).There was no correlation between serum TRAb titer and TSH,FT 3 and FT 4 during the medication course(P>0.05).There was low positive correlation between serum TRAb titer and drug dose in the initial treatment period(r=0.363,P=0.041),and no correlation with the treatment time(P>0.05).There was significant positive correlation between serum TRAb titer and drug dose and treatment time during the drug reduction period(r=0.679,P=0.001;r=0.640,P=0.001).Conclusion The positive rate of TRAb in newly diagnosed patients with

关 键 词：GRAVES病 促甲状腺激素受体抗体 抗甲状腺药物治疗 

分 类 号：R581.1[医药卫生—内分泌]