弥漫性毒性甲状腺肿抗中性粒细胞胞浆抗体临床分析及相关文献复习
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摘要: 目的:了解初诊弥漫性毒性甲状腺肿(Graves病,Graves disease,GD)患者抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies, ANCA)及甲状腺过氧化物酶抗体(thyroperoxidase antibodies, TPOAb)检出情况,并分析ANCA与TPOAb的关系。方法:将60例初诊未经治疗的GD患者设为研究组,40名体检健康者设为对照组,采用间接免疫荧光法检测血清ANCA,采用放射免疫分析方法检测TPOAb,比较2组ANCA及TPOAb的检出情况;检索1994~2005年有关初诊GD与ANCA关系的研究文章进行荟萃分析。结果:研究组仅2例(3%)初诊未治疗GD患者检测出ANCA(均为c-ANCA型),对照组均未检测出ANCA,2组检出率比较差异无统计学意义。34例(57%)GD患者TPOAb阳性,对照组无TPOAb阳性者,2组比较差异有统计学意义(P<0.01)。而GD患者中TPOAb阳性与阴性患者的ANCA检出率比较差异无统计学意义[2例(5.9%)与0]。有关初诊未治疗GD的研究文章共9篇,ANCA检出率为0~50%(除1篇检出率为50%外,其余检出率0~6%)。结论:初诊GD患者ANCA检出率较低,GD患者的ANCA可能与TPOAb无交叉反应。Abstract: Objective:To determine the frequency and specificity of antineutrophil cytoplasmic antibodies (ANCA) and thyroperoxidase antibodies(TPOAb) in a series of patients with untreated newly-diagnosed Graves disease and to evaluate the relationship between ANCA and TPOAb. Methods:Sixty patients with untreated newly-diagnosed Graves disease were assigned to study group and forty health subjects with euthyroid were used as control group. Serum ANCA was determined by indirect immunofluorescence. Serum TPOAb was detected by radioimmunoassay. The prevalence of ANCA and TPOAb was compared between the two groups. Meta-analysis was performed on the publications about the relationship between ANCA and untreated Graves disease during 1994~2005. Results:ANCA(cANCA) was detected only in 2 of 60(3%) serum samples of study group and was not detected in control group. There were no significant differences between the two groups.TPOAb was detected 34 of 60 (57%) patients with GD and was not detected in control group. There were significant differences between the two groups(P<0.01). There was no significant difference in ANCA positivity between TPOAb-positive and negative group. Nine publication were found with a prevalence of 0~50%(0~6% except in 1 publication where the prevalence was 50%). Conclusion:The detection rate of ANCA in Graves disease is low.There is probably no cross reaction between ANCA and TPOAb.
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