甲状腺内注射免疫抑制剂治疗Graves病的疗效观察及机制探讨

Efficacy of intrathyroid injection of immunosuppressor in the patients with Graves′ disease

目的观察甲状腺内注射免疫抑制剂对Graves病的疗效及对周围血中促甲状腺素受体抗体(TRAb)水平的影响,并探讨其机制。方法诊断明确的Graves病初发患者56例,随机分组,各组均口服甲巯咪唑及普萘洛尔,A组并予地塞米松注射液2.5 mg+环磷酰胺50 mg甲状腺内注射,每周1次,共10次;B组予地塞米松注射液2.5 mg甲状腺内注射;C组给予注射用水1 ml甲状腺内注射,每周1次,共10次;比较治疗前后及各组间临床症状、体征及血清游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)及TRAb变化。结果各组均能有效控制甲亢、降低FT3、FT4,但A、B组症状改善时间均小于C组(P<0.05),甲状腺缩小程度均大于C组(P<0.05),A、B组间比较无显著性差异(P>0.05);A、B组TRAb转阴率明显高于C组(P<0.01),A组与B组比较12周时有显著性差异(P<0.05)。结论甲状腺内注射免疫抑制剂治疗Graves病可较快改善症状,缩小甲状腺肿,缩短疗程,安全有效;其机制与其阻断甲状腺自身抗体、纠正机体免疫紊乱作用有关。

Objective To observe the effect of intrathyroid injection of immunosuppressor in patients with Graves＇ disease and study its mechanism. Methods Fifty - sit patients with Graves＇ disease were randomly divided into three groups. They were all treated with oral methimazol and propanolol plus intrathyroid injection of drugs. Injection of 2.5 mg dexamethasone and 50 mg cyclophosphamide was given to group A once a week for ten times, injection of 2.5 mg dexamethasone alone to Group B, and injection only of sterile water to Group C. Clinical symptoms and signs, serum FT3 , FT4 and thyrotropin receptor （TRAb） were observed before and after the treatment. Results The symptoms could be effectively controlled in all of the 3 groups along with the decrease of serum FT3 and FT4 , but the symptomatic improvement was less lasting in groups A and B than in group C （ P 〈0.05）. The shrinkage of thyroid was more marked in groups A and B （P 〈 0.05 ） though no significant differences were there between group A and group B （ P 〉 0.05 ）. The negative conversion rate of serum TRAb was significantly higher in groups A and B than in group C （ P 〈 0.01 ）, with certain differences significant between group A and group B at 12 week （ P 〈 0.05 ）. Conclusion Intrathyroid injection of immunosuppressor is a promising therapy for Graves＇ disease. Its combined use with oral antithyroid drugs may enhance the relief of symptoms and shrinkage of goiter. The mechanism here is probably associated with an inhibitory effect on the production of TRAb by thyroid lymphocytes and a simultaneous correction of the altered immunoreactions.