^(131)I治疗Graves病免疫状态变化的规律及临床价值

Study of the Rule and Clinical Value of Thyroid Immune State during the Treatment of Graves Disease with ^(131)I

目的动态检测131I治疗Graves病(GD)后的免疫学相关指标,探讨其变化规律与疗效的关系。方法随机选取149例GD患者分为A组(92例),131I治疗加用免疫调节剂,B组(57例)单用131I治疗。患者治疗前及治疗后1,3,6,9,12个月检查TRAb,TMA,TGA,IL-2,IL-6,CD4+,CD8+免疫指标,并注意观察疗效。随机抽取正常健康人20例作对照组。结果①GD患者TRAb,TMA,TGA,IL-2,IL-6治疗前明显高于正常人(P<0.05)。治疗后两组患者的检测指标的消长规律随时间延长呈下行曲线递减,B组下降速度较A组缓慢;②GD患者在治疗前CD4+高于正常,CD8+低于正常人(P<0.05),CD4+/CD8+比值明显增高。治疗后6个月与治疗前相比差异有显著性(P<0.05);③131I治疗后,25例1年内恢复正常。早发甲低患者中24例治疗前TRAb,TGA,TMA均为阳性,单纯TRAb阳性6例。结论①除TRAb外,TMA,TGA,IL-2,IL-6免疫分子也参与了GD的发生、发展过程,该类分子的含量变化与GD病情归转相关;②CD4+,CD8+T细胞亚群失衡,可能是GD的始动因子之一;③下调TRAb,TMA,TGA,IL-2,IL-6水平和纠正CD4+,CD8+T细胞亚群失衡的药物,可用于GD内照射治疗的同时,降低早发甲低的发生率,提高治愈率。

Objective Throgh dynamic examining some related immune markers during the treatment of Graves Disease with ^131I to study the relationship between the rule of its change and clinical effects. Methods One hundred and forty-nine GD patients were included in the study and they were randomly assigned to two groups. One group（A group） received therapy of immunoregulator when treated with ^131I and the other group（ B group） were only theated with ^131I by inner irradiation. All the patients were detected TRAb,TMA,TGA,IL-2,IL-6 and Subgroups of T lymphocyte （CD4^＋ CD8^＋） for estimating the change of thyroid immune system at before treating and 1,3,6,9,12 months after treating. Twenty health persons were enrolled as control group. Data were analyzed with the soft SPSS.Results （1） The pre-therapy level of TRAb,TMA,TGA,IL-2 and IL-6 of all the GD patients were significantly higher than the normal controls（P〈0.05）.After receiving the teatment.they fell faster in A group than the B group. There were significance between the two groups;（2）GD patients have significantly more CD4^＋ cells（P〈0.05） while fewer CD8^＋ cells （P〈0.05） than the normal controls before treating, and this made the ratio of CD4^＋/CD8^＋ higher. After six monthes treating, there exited significant changes（P〈0.05）;（3）Thirty patients suffered from premature hypothyroidism and 25 patients resumed in one year, and 5 patients were still in last premature hypothyroidism. Conclusions （1） Except for TRAb, immunomolecules（conclude TGA TMA IL-2 IL-6） also participate the development of GD, the changes of their concentration associates with the prevision of GD;（2） The disequilibrium of subgroups（CD4^＋CD8^＋） of T lymphcytes is one of promotors of GD;（3）The immunoregulator is used when GD is treated with ^131I, because the immunoregulator can pull down the ocurrance rate of premature hypothyroidism.