혈청 갑상샘자극호르몬수용체 자가항체와 갑상샘눈병증의 중증도 및 활동성과의 관계
Relationship between Serum Thyroid-stimulating Hormone Receptor Autoantibodies and Activity and Severity of Thyroid Eye Disease
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목적: 혈청 갑상샘자극호르몬수용체 자가항체 농도와 갑상샘눈병증(thyroid eye disease) 활성도 및 중증도와의 연관성을 관찰하고자 한다. 대상과 방법: 2014년 3월부터 2019년 12월까지 갑상샘눈병증으로 진단된 315명의 환자의 단면조사연구를 시행하였다. 질환의 활성도 평가를 위해 질병활성도(clinical activity score)가 사용되었고, 중증도 평가는 modified NOSPECS score가 사용되었다. 혈청 갑상샘자극호르몬수용체 자가항체 농도는 두 가지 분석법으로 측정되었다: 갑상샘자극호르몬 결합억제 면역글로불린(TSHR binding inhibitory immunoglobulin, TBII) 측정법과 갑상샘자극면역글로불린(thyroid stimulating immunoglobulin, TSI) 측정법. 각 분석법의 검사 결과, 갑상샘눈병증 활성도/중증도 상관관계를 분석하였다. 결과: 두 분석법(TBII, TSI)에서 갑상샘자극호르몬수용체 자가항체 농도와 질병활성도(각각, R=0.113, R=0.211; p＜0.05), 중증도(각각, R=0.173, R=0.316; p＜0.05), 안구돌출(각각, R=0.136, R=0.167; p＜0.05)이 유의한 상관관계를 보였다. 또한, 압박시신경병증, 각막상피결손 유무에서도 유의한 차이를 보였다. 결론: 두 분석법을 이용한 갑상샘자극호르몬수용체 자가항체 농도는 각막침범, 시신경병증 유무 및 갑상샘눈병증 활성도/중증도와 관련하여 임상증상과 유의한 상관관계가 있음을 보여주었다.
Abstract
Purpose: To study the relationship between the levels of serum thyroid-stimulating hormone (TSH)-receptor autoantibodies (TRAbs) and thyroid eye disease (TED) activity and severity scores. Methods: A cross-sectional study was performed. The medical records of 315 patients diagnosed with TED between March 2014 and December 2019 were reviewed. The clinical activity score (CAS) was used to assess TED activity and a modified NOSPECS score was used for severity grading. The serum TRAb level was measured using two assays: a TSHR binding inhibitory immunoglobulin (TBII) assay and thyroid stimulating immunoglobulin (TSI) bioassay. Results: The TBII and TSI assay results were significantly positively correlated with the CAS (R = 0.113 and 0.211, respectively; p < 0.05), modified NOSPECS score (R = 0.173 and 0.316, respectively; p < 0.05), and proptosis (R = 0.136 and 0.167, respectively; p < 0.05). Both assays demonstrated significant differences in the level of TRAb between patients with and without compressive optic neuropathy or corneal epithelial defects. Conclusions: The levels of TRAbs according to both TBII and TSI assays showed significant correlations with clinical signs of corneal involvement, optic neuropathy, and TED activity and severity.
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