Graves病介入术后甲状腺细胞凋亡因子的表达

Study of the expression for apoptosis factors of thyroid cells after arterial embolization to treat hyperthyroidism caused by Graved' disease

目的研究Graves病(GD)介入治疗前后凋亡调节蛋白Fas、FasL、Bcl-2、Bax、P53表达改变,了解GD介入治疗术前、术后凋亡因子表达情况及凋亡与疗效的关系。方法对15例GD患者的150μmPVA微粒及平阳霉素栓塞甲状腺动脉治疗,于术前、术后44例次成功穿刺甲状腺取标本行切片免疫组化分析,其中术前15例次、栓塞术后1年内16例次、术后1年以上13例次。采用免疫组化半定量积分法检测GD患者Fas、FasL、Bcl-2、Bax及P53表达情况。结果①术后15例中9例停药6个月以上无复发,为长期缓解,6例少量抗甲状腺药物(ATD)维持(用药量<术前用药量的1/4,甲状腺功能正常)为好转。②Fas和FasL阳性细胞数及着色程度均高于术前GD甲状腺组织(P<0.05)。③术后1年内组与术前组Bax阳性细胞数及着色程度均较强(两组比较,P>0.05),但术后1年以上Bax阳性细胞数及着色程度高于术前组(P<0.05);Bcl-2阳性细胞数及着色程度术前术后均无明显差别。④术后P53阳性细胞数及着色程度明显高于术前(P<0.05)。结论甲状腺动脉栓塞治疗GD后促凋亡基因Fas、FasL、Bax及P53表达增强,抗凋亡因子Bcl-2表达无增强。表明GD介入栓塞治疗是从甲状腺腺体细胞凋亡调节的水平发挥了有效的治疗作用。

Objective To study the expressions of Fas, FasL, Bax, Bcl-2 and P53 in thyroid tissue and to analyzis （Semi-quantitative analysis）the relation between change of apoptosis in thyroid tissues and clinical therapeutic effect after thyroid arterial embolization in treating hyperthyroidism caused by Graves＇disease with observation of apoptosis for 3 years. Methods 15 patients undergone core needle biopsy of the thyroid gland were divided into three groups according to the amount of time elapsed after thyroid arterial embolization： A group, before thyroid arterial embolization, B group, 1 year group （including 7-day subgroup, 3-month subgroup,6-month subgroup） and C group,1 year subgroup and more than 1 year subgroup after arterial embolization. Results ①Mter embolisation, 15 patients＇ symptoms and signs of hyperthyroidism disappeared or improved greatly with 9 long term released and 6 improved with small amount of ATD maintenance. ②The positive staining of Fas and FasL located in endochylema and cell-membrane of thyroid tissue from patients treated with transeathter arterial embolization were higher than those not treated with transeathter arterial embolization（P 〈 0.05）. ③The positive staining of Bax and Bcl-2 were present in endochylema. The positive cell and the staining of Bax showed no significantly statistical difference between A group and B group, but there was significantly statistical difference between A group and C group. The positive cell and the staining of Bcl-2 demonstrated no significantly statistical difference（P 〉 0.05 ）. ④The positive cell and the staining of P53 in thyroid tissue had significant difference before and after thyroid arterial embolization （P 〈 0.05）.Conclusions The extra-expression and the increased expression of Fas, FasL, Bax, P53 in thyroid tissue of patient with GD treated by thyroid arterial embolization are correlated with the effects of interventional therapy.