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TRAb对GD早期药物治疗的预测价值
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Abstract:
Graves病目前有ATDs、甲状腺手术及RAI三种治疗方法。ATDs在亚欧地区为首选，存在复发率高、药物不良反应等缺点。若能在疾病初期评估预后，医师可以精准地推荐治疗方案。我们发现存在甲状腺体积大、发病早、甲状腺毒症重、男性、有吸烟史、甲状腺低回声、高血流、碘缺乏状态、并发眼病、妊娠期等因素的GD甲亢患者中，ATDs治疗后复发的风险较高；而初诊及停药时TRAb (Thyrotropin receptor antibody)滴度越高或停药后抗体水平短期内升高的患者也更容易复发。TRAb对Graves病的诊断有明确意义，也可以一定程度上反映Graves病的预后，只是具体的预测价值尚有争议。许多国家和地区的指南也开始推荐TRAb作为指导用药和治疗的预测因素。因此，我们可以在临床工作中通过患者的性别、年龄、甲状腺形态、病史、生化等因素来综合评估GD预后、指导治疗，但仍需要进一步探索TRAb与Graves病复发概率的数量关系。
Graves’ disease has three therapeutic methods as ATDs, thyroidectomy and radioactive iodine (RAI). ATDs, as the first choice in Asia and Europe, have weakness like high recurrence rate and adverse drug reactions. If we can evaluate the prognosis in the early stage, clinicians can accurately recommend treatment. We find that GD hyperthyroidism patients with large thyroid volume, early onset, severe thyrotoxicosis, male, smoking history, hypothyroidism, hyperblood flow, iodine deficiency status, concurrent ophthalmopathy, pregnancy have higher risk of recurrence after ATDs treatment. Patients with higher thyrotropin receptor antibody (TRAb) titer at initial and withdrawal or with elevated antibody level in a short time after withdrawal are also easy to relapse. TRAb has definite significance in the diagnosis of Graves’ disease and can also reflect the prognosis of Graves’ disease to a certain extent, but the exactly predictive value of TRAb is still controversial. However, many national and regional guidelines have already recommend TRAb as a predictor of drug use and treatment. Therefore, we can comprehensively evaluate the prognosis of GD and guide treatment through the patient’s gender, age, thyroid morphology, medical history, biochemistry and other factors in clinical work, but we still need to further explore the corresponding relationship between TRAb and the recurrence probability of Graves’ disease.
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