全球精选文摘 - 慢性淋巴细胞性甲状腺炎的儿童和青少年患者中促甲状腺素受体阻断性抗体的产生情况及其功能意义

Prevalence and Functional Significance of Thyrotropin Receptor Blocking Antibodies in Children and Adolescents with Chronic Lymphocytic Thyroiditis

Feingold SB, Smith J, Houtz J 2010/6/22 11:48:26

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J Clin Endocrinol Metab, 2009,

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Context:
TSH receptor (TSHR) blocking antibodies (Abs) inhibit TSH-induced thyroid growth and function insomeadults with chronic lymphocytic thyroiditis (CLT), but their role in the pediatric age range is unknown.

Objectives:
Our objectives were: 1) to determine the prevalence of TSHR blocking Abs in children and adolescents with CLT and 2) assess their functional significance both in vivo and in vitro.

Design and Setting:
This was a retrospective study in a referral outpatient setting.

Patients:
Sera from a total of 87 CLT patients and 33 controls were studied.

Main Outcome Measures:
TSHR Abs were measured by both ELISA and bioassay.

Results:
Eight of 87 children and adolescents with CLT (9.2%), including one as young as 4yr of age, had TSHR Abs in serum as measured by ELISA. The prevalence was significantly higher in individuals whose serum TSH concentration was 20mU/liter or greater within 3 months of study than in less hypothyroid patients (eight of 45 vs. none of 42, P<0.005). Conversely, TSHR Ab-positive patients were significantly more hypothyroid at diagnosis but onlywhenthe analysis was restricted to those with severe hypothyroidismwasa decreased prevalence of goiter observed. IgG purified from TSHR Ab sera retained the TSH binding-inhibitory activity and TSHR Ab-positive sera inhibited TSH-induced stimulation of cAMP significantly more than normal.

Conclusions:
TSHR-blocking Abs contribute significantly to the severity of the hypothyroidism in some children with CLT, but as compared with adults, they appear to play less of a role in determining the presence or absence of a goiter.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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