Graves病患者的促甲状腺素受体抗体与甲状腺刺激性免疫球蛋白及甲巯咪唑治疗反应的相关性

Correlation between thyrotropin receptor antibody and thyroid-stimulating immunoglobulin and methimazole responsiveness in patients with Graves' disease

摘要:

目的： 评估Graves病（Graves' disease，GD）患者促甲状腺激素受体抗体（thyrotropin receptor antibody，TRAb）与甲状腺刺激性免疫球蛋白（thyroid-stimulating immunoglobulin，TSI）水平之间的相关性，比较TRAb和TSI对甲巯咪唑治疗反应的临床预测能力。方法： 收集2020年1月至2021年12月在江苏省中西医结合医院就诊的患者2 145例。使用Pearson分析方法对游离甲状腺素（free thyroxine，FT4）、TRAb、TSI进行相关性分析。从2 145名患者中选取50名接受甲巯咪唑治疗的GD患者并进行随访。收集患者基线资料，甲巯咪唑治疗期间患者甲状腺自身抗体水平及甲巯咪唑剂量变化（Δ_甲巯咪唑）等。使用logistic回归分析确定与甲巯咪唑治疗快速反应性相关的预测因子。结果： GD患者的TRAb与TSI水平极强相关（P<0.001）。甲巯咪唑≥10 mg/d治疗的GD患者中FT4、TRAb、Δ_甲巯咪唑与治疗反应显著相关（均P<0.05），TSI无统计学意义；甲巯咪唑<10 mg/d治疗的GD患者中各指标均与治疗反应无关（均P>0.05）。受试者工作特征（receiver operating characteristics，ROC）曲线显示FT4水平是GD患者对甲巯咪唑治疗快速反应的最佳预测因子。结论： GD患者的TRAb水平与TSI水平密切相关。与TRAb相比，TSI对甲巯咪唑的治疗反应性可能更弱。

Abstract:

Objective: To evaluate the correlation between thyrotropin receptor antibody (TRAb) and thyroid-stimulating immunoglobulin (TSI) levels, and to compare the clinical ability of TRAb and TSI in predicting methimazole responsiveness in patients with Graves' disease (GD) . Methods: A total of 2 145 patients treated in the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine from January 2020 to December 2021 were recruited. The correlations between free thyroxine (FT4) , TRAb and TSI levels were assessed by Pearson correlation analysis. Of the 2 145 patients, 50 GD patients treated with methimazole were followed up in our center. Baseline characteristics, thyroid autoantibody levels and doses of methimazole during treatment (Δ_methimazole) were retrospectively analyzed. Clinical predictors of rapid responsiveness to methimazole in GD patients were identified by logistic regression analysis. Results: TRAb level was strongly correlated with TSI level in GD patients (P<0.001) . FT4, TRAb and Δ_methimazolewere significantly correlated with rapid responsiveness to methimazole in GD patients treated with≥10 mg/d methimazole (all P<0.05) , and TSI was not statistically significant. While all indicators were not correlated with the rapid responsiveness to methimazole in GD patients treated with<10 mg/d methimazole (all P>0.05) . The receiver operating characteristic (ROC) curves revealed that FT4 level was the optimal predictor of rapid responsiveness to methimazole in GD patients. Conclusion: TRAb level is closely correlated with TSI level in GD patients. Compared with TRAb, TSI is likely less predictive of methimazole responsiveness.