Association of thyrotrophin receptor antibodies with the clinical features of Graves' ophthalmopathy
Association of thyrotrophin receptor antibodies with the clinical features of Graves' ophthalmopathy
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DOI：
10.1046/j.1365-2265.2000.00959.x
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发表时间：
2000-03-01
影响因子：
3.2
通讯作者：
Prummel, MF
中科院分区：
文献类型：
--
作者：
Gerding, MN;van der Meer, JWC;Prummel, MF
目的Graves眼病（GO）和Graves甲亢是两种密切相关的疾病，被认为是由同一自身免疫过程引起的。一个明显的解释是存在自身抗体与眼眶和甲状腺中的自身抗原反应。TSH受体（TSH-R）抗体是一个可能的候选者，因为它们会导致Graves'甲状腺功能亢进症，并且TSH-R似乎也存在于眼眶组织中。如果TSH-R抗体是眼病的原因，则可以预期其滴度与眼病的临床特征相关。本研究的目的是了解TSH-R抗体是否与甲状腺相关眼病的活动性和严重程度有关。设计和患者TSH-R抗体水平测定为TBII（TRAK测定）和TSI（TSH-R转染细胞系的cAMP反应）在63名患有未治疗的中重度GO并伴有Graves甲状腺疾病的患者的血清中;结果TBII与TSI滴度呈高度正相关。TBII或TSI滴度与甲状腺或眼眶疾病持续时间无关，也与TPO抗体水平无关。相比之下，我们发现眼病的临床活动评分（CAS）与TBII（r = 0.54; P < 0.0001）和TSI（r = 0.50; P < 0.0001）之间存在显著且高度显著的相关性。此外，眼球突出（mm）与TBII（r = 0.36; P = 0.004）和TSI（r = 0.49; P = 0.0001）之间存在较弱但显著的相关性。结论甲状腺激素受体抗体水平与Graves眼病的临床特征有直接相关性。本研究结果支持Graves眼病患者眼眶中TSH-R抗体和TSH-R的发病作用的假设。
OBJECTIVE Graves' ophthalmopathy (GO) and Graves' hyperthyroidism are closely associated diseases and thought to be caused by the same autoimmune process. An obvious explanation for this would be the presence of autoantibodies reacting with an autoantigen present in the orbit and the thyroid gland. The TSH-Receptor (TSH-R) antibodies are a likely candidate, because they cause Graves' hyperthyroidism and the TSH-R appears to be present also in orbital tissues. If TSH-R antibodies are responsible for the ophthalmopathy one would expect their titres to correlate with clinical characteristics of the eye disease. The aim of the present study is to see whether TSH-R antibodies are related to the activity and severity of the thyroid-associated ophthalmopathy.DESIGN AND PATIENTS TSH-R antibody levels were measured as TBII (TRAK assay), and TSI (cAMP response of a TSH-R transfected cell line) in serum of 63 patients with untreated moderately severe GO, accompanying Graves' thyroid disease; all patients had been euthyroid for > 2 months.RESULTS TBII and TSI titres were strongly related to each other. TBII or TSI titres did not correlate with thyroidal or orbital disease duration, nor with TPO antibody levels. In contrast, we found a striking and highly significant correlation between the Clinical Activity Score (CAS) of the eye disease, and both TBII (r = 0.54; P < 0.0001) and TSI (r = 0.50; P < 0.0001). In addition, a weaker but significant relation was found between proptosis (in mm) and TBII (r = 0.36; P = 0.004) and TSI (r = 0.49; P = 0.0001). No correlation was found with eye muscle motility.CONCLUSION TSH-R antibody levels correlate directly with clinical features of Graves' ophthalmopathy. The results support the hypothesis of a pathogenetic role of TSH-R antibodies and the TSH-R in the orbit of Graves' ophthalmopathy patients.