갑상샘눈병증과 혈청 자가항체의 관련성에 관한 연구
Association Between Thyroid Associated Ophthalmopath and Thyroid Autoantibody
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
목적: 그레이브스병 환자의 혈청 자가항체와 갑상샘눈병증과의 관련성을 알아보고자 하였다. 대상과 방법: 2006년 1월부터 2009년 12월까지 본원에 내원하여 그레이브스병으로 처음 진단된 환자 중 안과 진료를 시행한 환자를대상으로 혈청 자가항체 값을 알아보고, 갑상샘눈병증 유무와의 관련성을 조사하였다. 또한 갑상샘눈병증으로 진단된 환자군에서 혈청자가항체들 사이의 관련성을 알아보았다. 결과: 전체 183명의 환자 중 갑상샘눈병증으로 진단된 환자는 108명이었다. 갑상샘자극호르몬 수용체 항체의 경우 갑상샘눈병증이있는 군에서 더 높은 항체 양성률을 보였고, 항갑상샘과산화효소 항체 및 항티로글로불린 항체의 경우는 갑상샘눈병증이 없는 군이있는 군보다 더 높은 항체 양성률을 보였다. 갑상샘눈병증으로 진단된 환자군에서 항갑상샘과산화효소 항체와 항티로글로불린 항체사이에는 높은 상관 관계(r=0.64, p=＜0.001)를 보여주었다. 결론: 그레이브스병 환자에서 혈청 자가항체는 갑상샘눈병증 유병 여부와 유의한 연관성을 보였다. 따라서 혈청 자가항체는 갑상샘눈병증의 진단에 있어 유용하게 사용될 수 있을 것으로 사료된다.
Abstract
Purpose: The same autoimmune process is thought to cause thyroid associated ophthalmopathy (TAO) and Graves disease. The aim of this study is to determine whether thyroid autoantibody is related to the development of thyroid associated ophthalmopathy. Methods: A retrospective chart analysis was performed on patients with a newly diagnosed Graves’ disease, who presented to our ophthalmology clinic between January 2006 and December 2009. Thyroid autoantibody titers were obtained at the time of diagnosis and were used to determine the presence or absence of TAO. In addition, any correlations between thyroid autoantibodies were analyzed in patients with TAO. Results: Thyroid autoantibody levels correlated with the development of TAO. Fifty-eight (69%) out of 84 patients with positive thyroid-stimulating hormone receptor antibody (TRAB) levels at the time of diagnosis had TAO. Only 50 (51%) of the 99 patients with negative TRAB levels had TAO. This difference between the two groups was statistically significant (odds ratio, OR=2.2, p=0.013). A statistically significant correlation with the development of TAO was also found in thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb), respectively (OR=0.5, p=0.317; OR=0.3, p=＜0.001). In patients with TAO, the correlation between TPOAb and TgAb levels was very high (r=0.64, p=＜0.001). Conclusions: A significant association was determined to exist between the development of TAO and thyroid autoantibody level. This result demonstrates the clinical utility of thyroid autoantibody for the diagnosis of TAO in patients with newly diagnosed Graves disease.
참고문헌 (21)
- Feliciello A, "Expression of thyrotropinreceptor mRNA in healthy and Graves’ disease retro-orbital tissue", Lancet, 342, pp.337~338 (1993)
- Heufelder AE, "Detection of TSH receptor RNA in cultured fibroblasts from patients with Graves’ ophthalmopathy and pretibial dermopathy", Thyroid, 3, pp.297~300 (1993)
- Ludgate M, "The thyrotropin receptor in thyroid eye disease", Thyroid, 8, pp.411~413 (1998)
- Marinò M, "Identification of thyroglobulin in orbital tissues of patients with thyroid-associated ophthalmopathy", Thyroid, 11, pp.177~185 (2001)
- Lisi S, "Thyroglobulin in orbital tissues from patients with thyroid-associated ophthalmopathy: predominant localization in fibroadipose tissue", Thyroid, 12, pp.351~360 (2002)
- Khoo DH, "The combination of absent thyroid peroxidase antibodies and high thyroid-stimulating immunoglobulin levels in Graves’ disease identifies a Group at markedly increased risk of ophthalmopathy", Thyroid, 9, pp.1175~1180 (1999)
- Gerding MN, "Association of thyrotrophin receptor antibodies with the clinical features of Graves’ ophthalmopathy", Clin Endocrinol, 52, pp.267~271 (2000)
- Konishi J, "Binding of thyroglobulin and thyroglobulin-antithyroglobulin immune complex to extraocular muscle membrane", Endocrinology, 95, pp.434~446 (1974)
- 임원일, "갑상선 안병증과 갑상선 기능상태의 연관성", 대한안과학회지, 43(3), pp.431~436 (2002), 대한안과학회
- Southgate K, "A receptor assay for the measurement of TSH receptor antibodies in unextracted serum", Clin Endocrinol, 20, pp.539~548 (1984)
- Dolman PJ, "VISA Classification for Graves orbitopathy", Ophthal Plast Reconstr Surg, 22, pp.319~324 (2006)
- 우경인, "한국인 갑상샘 기능 이상 환자에서 갑상샘눈병증의 임상 특징", 대한안과학회지, 49(9), pp.1387~1396 (2008), 대한안과학회
- Mourits MP, "Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy", Clin Endocrinol (Oxf), 47, pp.9~14 (1997)
- 박정민, "안과 초진시 갑상선항진증 환자의 안증상 및 외안근의 변화", 대한안과학회지, 44(10), pp.2197~2203 (2003), 대한안과학회
- Rhee KC, "The clinical study on Graves' ophthalmopathy", J Korean Ophthalmol Soc, 40, pp.2923~2927 (1999)
- Bartley GB, "Clinical features of Graves' ophthalmopathy in an incidence cohort", Am J Ophthalmol, 121, pp.284~290 (1996)
- Gupta MK, "Thyrotropin receptor antibodies: advances and importance of detection techniques in thyroid diseases", Clin Biochem, 25, pp.193~199 (1992)
- Orgiazzi J, "Anti-TSH receptor antibodies in clinical practice", Endocrinol Metab Clin North Am, 29, pp.339~355 (2000)
- Lissak B, "Thyroid orbital pathologies in ophthalmological settings", Presse Med, 31, pp.64~68 (2002)
- Goh SY, "Thyroid autoantibody profiles in ophthalmic dominant and thyroid dominant Graves' disease differ and suggest ophthalmopathy is a multiantigenic disease", Clin Endocrinol (Oxf), 60, pp.600~607 (2004)
- Eckstein AK, "Clinical results of anti-inflammatory therapy in Graves' ophthalmopathy and association with thyroidal autoantibodies", Clin Endocrinol (Oxf), 61, pp.612~618 (2004)