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1、·360·中华内分泌代谢杂志2011年4月第27卷第4期摇ChinJEndocrinolMetab,April2011,Vol.27,No.4誗综述誗促甲状腺激素受体抗体检测的临床意义杨昱摇郑昂摇刘超摇蔡可英摇摇揖提要铱摇50年前人们发现了促甲状腺激素受体抗体(TRAb),随着对促甲状腺激素受体(TSHR)结构和功能认识的不断更新,加之TSHR信号转导和与TRAb相互作用的逐步阐明,人们对TRAb及其临床应用的认识得到了进一步提高。TRAb的检测在Graves病(GD)及Graves眼病的诊断中有重要作用,并有效预测GD经抗甲状腺药物或放射性碘治疗后复发。其亦可应用
2、于近期服碘的孕妇和乳母,因为甲状腺扫描对她们来说是禁忌的。另外,TRAb有助于胎儿、新生儿甲状腺功能亢进及其他类型的甲状腺毒症的诊断和鉴别诊断。目前,已有文献报道TRAb阳性的GD患者发生甲状腺肿瘤及不良预后之间的可能联系,但尚需更多的前瞻性研究来证实。揖关键词铱摇促甲状腺激素;促甲状腺激素受体抗体;格雷夫斯病;方法学*Clinicalimplicationsofthyrotropinreceptorantibodymeasurement摇摇YANGYu,ZHENGAng,LIUChao,*CAIKe鄄ying.EndocrineandDiabetesCenter,
3、JiangsuProvinceHospitalonIntegrationofChineseandWesternMedicine,Nanjing210028,ChinaCorrespondingauthor:LIUChao,Email:liuchao@nfmcn.com揖Summary铱摇Ithasbeen50yearssincethediscoveryofthyrotropinreceptorautoantibody(TRAb).Advancesintheknowledgeofthyrotropinreceptor(TSHR)structureandfunction
4、,combinedwiththeelucidationofTSHRsignalingandTSHR鄄autoantibodyinteractionhavegreatlyfacilitatedourunderstandingofTRAbandtheirclinicalapplications.MeasurementofTRAbactivityplaysanimportantroleinthediagnosisofGraves忆disease(GD)andGraves忆opthalmopathy.IthasalsobeenwellrecognizedthatTRAbis
5、aneffectivepredictorofGDrelapseorremissionafterantithyroiddrugandradioactiveiodinetreatment.TRAbtestisofparticularhelpinpregnantwomenandlactatingmotherswithrecentiodineload,whereradioactiveiodineortechnetiumtestsarecontraindicated.Inaddition,itisusefulinthediagnosisanddifferentialdiagn
6、osisoffetalandneonatalhyperthyroidismaswellassomerareformsofthyrotoxicosisinclinicalpractice.AccumulatingevidencealsoindicatesthepossiblecorrelationbetweenthyroidcanceroccurringinGDpatientswithpositiveTRAbandadverseoutcomes.However,furtherinnovationandstandardizationofTRAbtestsarerequi
7、redtohelppavethewayforclinicalapplications.揖Keywords铱摇Thyrotropin;Thyrotropinreceptorantibody;Graves忆disease;Methodology(ChinJEndocrinolMetab,2011,27:360鄄364)摇摇自身免疫性甲状腺疾病(autoimmunethyroiddiseases,TRAb包括3个类别:(1)TSH受体抗体(TRAb):也称为TSHAITD)是一组最为常见的器官特异性内分泌疾病,其特征为因结合抑制免疫球蛋白(TSHbindinginhi
