慢性淋巴细胞性甲状腺炎的局部免疫调节治疗

Local immune regulation therapy for chronic lymphocytic thyroiditis

目的评价局部免疫调节治疗对慢性淋巴细胞性甲状腺炎(CLT)患者的治疗效果和安全性。方法选择81例CLT患者,采用甲状腺内局部注射糖皮质激素的方法,观察治疗前后患者自觉症状、甲状腺大小(B超测量)、甲状腺功能(TSH、FT3、FT4)和甲状腺过氧化酶抗体(TPoAb)等指标的变化。以患者的甲状腺功能正常或较前好转作为判定指标。结果(1)总有效率为66%;(2)患者甲状腺左右叶分别从治疗前的(7.55±0.57)cm3和(6.57±0.49)cm3下降至治疗后的(6.84±0.45)cm3和(5.80±0.46)cm3(P<0.05);(3)TPoAb从(338.2±43.2)mIU/L下降至(266.9±42.2)mIU/L(P<0.01);(4)TSH、FT3、FT4治疗前分别为(19.56±2.90)μIU/L、(4.43±0.23)pmol/L、(14.40±1.32)pmol/L,治疗后分别为(7.44±1.62)μIU/L、(4.52±0.19)pmol/L、(14.82±0.75)pmol/L,TSH明显下降,有显著性差异;FT3、FT4有上升的趋势,但是无统计学意义;(5)治疗前后患者自觉症状明显好转。结论局部免疫调节治疗CLT疗效确切、操作简便、安全价廉。

Objective To investigate the efficacy and safety of local immune regulation therapy （LIRT） on the patients with chronic lymphocytic thyroiditis（CLT）. Methods Eighty-one patients were recruited and completed LIRT. The symptoms, signs, thyroid volume, thyroid function and serum antithyroperoxidase antibody（TPoAb） levels were measured before and after the treatment. Effectiveness was determined according to the occurrence of euthyroidism or the improvement of thyroid function. Results The total effective rate was 66%. The volumes of left and right lobe of the thyroid reduced from 7.55 ± 0. 57 and 6.57 ± 0. 49 cm^3 to 6. 84± 0. 45 and 5.80 ± 0. 46 cm^3, respectively. TPoAb levels were decreased from 338. 2± 43. 2 to 266. 9 ± 42. 2 mIU/L（P〈0.01）. TSH level decreased profoundly from 19. 56±2. 90 to 7. 44±1.62μIU/L（P〈0. 01）,while FT3 increased from 4. 43±0. 23 to 4. 52±0. 19 pmol/L, and FT4 from 14. 40±1.32 to 14. 82±0. 75 pmol/L. The symptoms were significantly improved. Conclusion LIRT is a cost-saving, safe and simple treatment procedure for the patients with CLT.