甲泼尼松龙冲击治疗甲状腺相关性眼病时TRAb和sICAM-1的变化及意义

目的 探讨促甲状腺素受体抗体(TRAb)、可溶性细胞间黏附分子1(sICAM-1)与甲状腺相关性眼病(TAO)病情的相关性,及其在TAO发病机制中的作用.方法 对23例TAO患者,按照临床活动性评分及眼病严重程度分级分组,给予大剂量甲泼尼龙静脉冲击治疗.分别采用放射免疫法和酶联免疫吸附法,于治疗前及每个疗程结束后第2天测定空腹外周静脉血清中TRAb和sICAM-1的浓度.结果 TRAb水平与患者病情活动性相关(P=0.020);sICAM-1水平主要与患者眼病的病程相关(P=0.015);活动性眼病组患者接受激素冲击治疗过程中TRAb的水平持续稳定下降,第3个疗程后TRAb的水平较治疗前显著下降(P＜0.05);重复测量趋势分析示活动性与非活动性眼病患者接受大剂量甲强龙冲击后TRAb和sICAM-1的水平变化趋势均不同.结论 TRAb与TAO的活动性相关,可预测并客观评价糖皮质激素的疗效;sICAM-1与患者眼病的病程相关,但是非特异性使其水平的影响因素较多,不能客观地反映激素治疗的效果.

The significance of changes in thyrotropin receptor antibody and soluble intercellular adhesion molecule-1 levels in patients with thyroid-associated ophthalmopathy during intravenous methylprednisolone pulse treatment

Objective To explore the relationship of thyrotropin receptor antibody (TRAb) and soluble intercellular adhesion molecule-1 ( sICAM-1 ) in patients with thyroid-associated ophthalmopathy ( TAO), and the role played by TRAb and sICAM-1 in the pathogenesis of TAO. Method Twenty-three TAO patients were assigned to groups according to the clinical activity score and EUGOGO. All patients were treated with intravenous methylprednisolone pulse. The levels of serum TRAb and sICAM-1 were evaluated by a competitive radioimmunoassay and enzyme-linked immunosorbent assay respectively before treatment and by the end of each methylprednisolone pulse. Results The differernce in serum TRAb levels was associated with activity scores of TAO (P=0. 020). The change in serum sICAM-1 was associated with durations of TAO ( P = 0.015). During methylprednisolone treatment in active TAO patients, the levels of TRAb kept on decreasing gradually and markedly declined after the third methylprednisolone pulse in active TAO patients (P＜0.05). The trends of changes in serum TRAb and sICAM-1 levels were both different in active and inactive TAO patients by tendency analysis. Conclusion TRAb level was related to the activity of TAO and might serve as a significant predictor of response to methylprednisolone therapy. The negative correlation between sICAM-1 levels and duration of TAO corroborates the role played by ICAM-1 during the early stage of TAO. Higher sICAM-1 levels are not expected to be specific to TAO and may not predict a response to methylprednisolone therapy.