~(131)I治疗Graves’病后发生甲低与TGA,TMA及TRAb的关系

目的 :从甲状腺自身免疫方面探讨1 3 1 I治疗甲亢的效果及甲低发生的因素。方法 :选择1 3 1 I治疗的88例Graves’病甲亢患者随访 3年 ,分为第 1组 (TGA、TMA、TRAb均阳性 )和第二组 (TGA、TMA阴性 ,TRAb阳性 )。采用x2 分析自身抗体水平与甲低发生的关系。结果 :1组甲低发生率为 31 4 % ,2组为 3 8% ,1组明显高于 2组 ,差异有显著性。结论 :TGA、TMA和TRAb水平与确定1 3 1 I剂量及甲低的发生关系密切。认为TGA、TMA水平高的患者应酌情减少1 3 1 I用量     

Graves病中甲状腺自身抗体的动态变化及相关性分析

目的：研究Graves病（GD）发病时及在抗甲状腺药物治疗过程中促甲状腺素受体抗体（TRAb）和甲状腺过氧化物酶抗体（TPOAb）的变化。方法：应用ELISA对初发的和应用甲巯咪唑治疗不同阶段（3,6,12,18及24月）的GD患者血清进行TRAb、TPOAb检测。同时,对游离甲状腺素（FT4）、游离三碘甲腺原氨酸（FT3）和促甲状腺素（TSH）进行检测,并对TRAb、TPOAb和甲状腺功能（FT4,FL3,TSH）进行相关性分析。结果：232例初发的GD患者血清TRAb检测值中位数为0．86（OD405）,阳性率为73．7％（171／232）;TPOAb检测值中位数为0．55（0D405）,阳性率为28．9％（67／232）。治疗过程中,TRAb水平及阳性率稳步逐渐下降,而TPOAb水平在12个月前逐步上升,TPOAb阳性率也显示了上升趋势,然后逐渐下降。TRAb和TPOAb之间未发现相关性,它们与甲状腺功能之间也未发现相关性。结论：尽管TRAb和TPOAb是GD中的自身抗体,但它们反晦的是不同的免疫异常,而且这种免疫异常独立于甲状腺功能。     

~(131)碘治疗Grave′s病后检测血清TRAb的临床价值

目的:分析Grave′s病患者131碘治疗后的血清TRAb变化,探讨TRAb在131碘治疗甲亢中的应用价值。方法:采用放射受体分析法检测了101例131碘治疗的Grave′s病患者血清TRAb,根据131碘治疗后对血清TRAb变化进行对比分析。结果:甲亢持续组TRAb升高阳性率明显高于甲亢治愈组,两者之间差异有显著性(P<0.05)。而在131碘治疗后TRAb的变化与甲亢严重无关(P>0.05)。结论:TRAb检测在Grav′s病131碘治疗中具有重要指导作用。     

Graves病与Graves眼病的FT3、FT4、STSH、TGAb、TMAb、TRAb检测及临床意义

目的 探讨FT3、FT4、STSH、TGAb、TMAb、TRAb与Graves眼病(GO)的关系,了解各指标在GO患者发病中的作用.方法 采用放射免疫分析法检测64例Graves病(GD)患者及121例GO患者血清FT3、FT4、STSH、TGAb、TMAb、TRAb值,并对两组各指标的检测值及TRAb阳性检出率进行比较.结果 两组患者血清FT3、FT4、STSH、TGAb、TMAb活性差别无统计学意义(P＞0.05);GO组及GD组TRAb活性分别为(27.54±5.62)u/l和(11.48±9.55)u/l,GO组明显高于GD组(P＜0.05);GO组及GD组阳性检出率分别为72.73%和51.56%,GO组显著高于GD组(P＜0.005).结论 两组患者甲状腺的功能状态相同;TRAb在GO的诊断中具有重要意义;推测GD患者血清TRAb显著增高是合并或随病程延长可能合并GO的重要标志.     

正丁醇法制备大鼠脂肪组织细胞膜TSHR

目的:利用正丁醇对大鼠脂肪组织细胞膜上的促甲状腺素受体(TSHR)进行提纯,以获得膜受体的均一水溶性溶液。方法:使用差速离心法获得大鼠含TSHR脂肪组织细胞膜碎片后,用正丁醇进一步提纯;采用SDS-PAGE和ELISA法鉴定所得蛋白完整性、生物学活性,并用BCA法测定相关蛋白含量。结果:正丁醇提纯的大鼠TSHR结构完整;经正丁醇提纯后的TSHR包被酶标孔孔间测定值变异系数较未经正丁醇提取组以及阳性对照组低。结论:经正丁醇提纯后的大鼠TSHR可以满足临床ELISA法检测Graves病患者血清TRAb的要求,同时可以降低酶标孔间测定值的误差。     

甲亢患者手术前后TSH受容体抗体的变化及临床意义

目的探讨作为甲状腺机能亢进症（甲亢）主要发病因子的ＴＳＨ受容体抗体（ＴＲＡｂ）在甲状腺切除手术前、后的变化及其临床意义。方法对９１例甲亢患者进行ＴＲＡｂ追踪测定，并根据术前ＴＲＡｂ值将其分为正常组，弱阳性组，中度阳性组和强阳性组，分别讨论其变化特点。结果术前ＴＲＡｂ阳性例术后１２～１８月间大部分转为正常或呈明显下降趋势；而甲状腺机能则全部转为正常或潜在性低下及低下状态。阳性组ＴＲＡｂ术后恢复正常的例数所占比率分别为２５／２７、１０／１７和２／８。结论外科手术治疗甲亢可以使ＴＲＡｂ转为阴性，因此，不但在临床上而且针对病因治疗也都有效，但目前尚无法治愈所有甲亢患者。     

TGA、TPO-Ab、TRAb和TSH在自身免疫性甲状腺病中的临床应用

目的：探讨TGA、TPO-Ab、TRAb和TSH在自身免疫性甲状腺病中的诊断和鉴别诊断价值。方法：采用化学发光法检测80例自身免疫性甲状腺病患者（桥本甲状腺炎40例,Graves病40例）、50例甲状腺结节患者和40例正常对照者血清TGA、TPO-Ab、TRAb和TSH水平,通过ROC曲线评估最佳诊断阈值。结果：自身免疫性甲状腺病（桥本甲状腺炎和Graves病）患者与非自身免疫性甲状腺疾病（甲状腺结节）患者血清TGA、TPO-Ab的差异有统计学差异（P〈0.01）,非自身免疫性甲状腺病患者组与正常对照组比较无统计学意义（P〉0.05）。在自身免疫性甲状腺病患者中,Graves病患者TRAb水平高于桥本甲状腺炎患者（P〈0.01）,而TSH水平低于桥本甲状腺炎患者（P〈0.01）。通过ROC曲线分析,当TGA、TPO-Ab分别为70.2U/ml、105.65IU/ml时,对自身免疫性甲状腺病的诊断具有最高的灵敏度和特异性;当TRAb、TSH分别为2.25IU/ml、0.60μlU/ml时,对Graves病和桥本甲状腺炎的鉴别诊断价值最高。实验室建立的参考值与试剂盒提供的参考值比较,具有更高的特异性。结论：TGA和TPO-Ab对自身免疫性甲状腺病的诊断具有重要意义,而TRAb和TSH对鉴别诊断Graves病和桥本甲状腺炎具有重要的临床应用价值。每个实验室有必要建立自己的参考范围,为临床和病人提供更准确、有效的信息。     

Screening for thyroid disease and iodine deficiency

The high global prevalence of iodine deficiency and autoimmune thyroid disorders and the mental and physical consequences of these disorders creates a huge human and economic burden that can be prevented, in large part, by early detection and appropriate preventative or therapeutic measures. The availability of sophisticated, sensitive and accurate laboratory testing procedures provides an efficient and effective platform for the application of screening for these disorders. Measurement of urine iodine concentration (UIC) in school children or pregnant women is the recommended indicator for screening populations for iodine deficiency. The severity of the iodine deficiency is classified according to the UIC. Measurement of serum thyrotropin (TSH) as an indicator for population iodine deficiency is used only in neonates and is supplementary to UIC screening. Other indicators such as goitre rates, thyroid function and serum thyroglobulin levels are useful adjunctive but not frontline process indicators. The human and economic benefits of screening for congenital hypothyroidism by measurement of heel-prick TSH have been well documented and justify its universal application. Using this measurement for monitoring population iodine intake is recommended by the World Health Organization but further validation is required before it can be universally recommended. Subclinical thyroid dysfunction is readily detected by current highly sensitive serum TSH assays and its prevalence appears to increase with age, varies with iodine intake and ethnicity and may occur in up to 20% of older age people. Subclinical hyperthyroidism is the less common disorder and screening cannot be justified because of its low prevalence and minimal or insignificant clinical effects. The argument for screening for subclinical hypothyroidism in middle-aged and older women is stronger but lacks evidence of benefit from randomised controlled trials or cost benefit analyses of therapeutic intervention, so it cannot currently be recommended. The publication of recent Clinical Practice Guidelines for management of thyroid disease in pregnancy from the American Endocrine Society and American Thyroid Association provide persuasive arguments for early detection and treatment of overt and subclinical hypothyroidism to prevent obstetric complications and potential neurocognitive disorders in the offspring. Given the indisputable benefits of therapy, the sooner thyroid dysfunction is detected, before or as early as possible in gestation, the more likely there will be a better outcome. Because of the limitations of targeted case detection in women at risk of subclinical hypothyroidism, there has been a gradual shift in opinion to universal TSH screening of all women as soon as practicable in pregnancy. While a positive association exists between the presence of anti-thyroid antibodies and increased pregnancy loss, universal screening of all pregnant women for underlying autoimmune thyroid disease is difficult to justify until there is evidence of beneficial outcomes from randomised controlled trials. Vigorous and liberal targeted case detection remains the recommended strategy to address this problem.