甲状腺疾病患者血清可溶性细胞间粘附分子-1的研究

A study of soluble intercellular adhesion molecule-1 in sera of patients with thyroid diseases

目的探讨血清可溶性细胞间粘附分子-1（SICAM-1）水平与甲状腺疾病的关系。方法采用^125Ⅰ-sICAM-1 RIA方法，检测了健康人273名（对照组），Graves（GD）病患者557例，初诊慢性淋巴细胞性甲状腺炎（HT）患者33例，初诊单纯性甲状腺肿（SG）患者17例，初诊非毒性结节性甲状腺肿（NTNG）患者9例的血清sICAM-1水平，比较各组间差异及其与其他指标的相关性。变量资料为正态分布时，应用ANOVA或t检验进行组间比较；不满足条件时，应用秩和检验（Kruskal-Wallis或Mann-Whitney）进行分析。结果初诊GD组[58例，（255．04±82．40）ug/L]和HT组[（227．22±77．08）ug／L]sICAM-1水平均高于对照组[（149．89±39、45）-L]（GD：Z=-9．401，HT：Z=-5．902；P均〈0．01），而SG组[（173．82±59．50）ug/L]和NTNG组[（159．31±28．73）ug/L]与对照组差别无统计学意义（SG：Z=-1．9，NTNG：Z=-0．949；P均〉0．05）。初诊及各治疗阶段GD伴突眼组sICAM-1水平均高于非突眼组，但仅在治疗≥19个月组差异有统计学意义[（211．58±53．58）与（189．50±39．99）ug/L；t=2．004，P〈0．05]。复发GD突眼及非突眼组sICAM-1水平亦显著高于对照组（X^2=88．257，P〈0．01）。在经抗甲状腺药物（ATD）治疗后甲状腺功能恢复正常且病情稳定的GD患者中，sICAM-1水平随疗程延长逐步缓慢降低，且当疗程≥19个月时，GD组在非突眼及突眼患者中，其血清sICAM-1[（189．50±39．99），（211．58±53．58）ug/L]与各自初诊组[（244．75±81．58），（287．36±79．20）ug/L]差异有统计学意义（F=9．986和3．398，P〈0．01和P〈0．05），但直至停药时仍高于对照组[（185．25±39．64）与（149．89±39．45）ug/L；Z=-3．813，P〈0．05]。结论血清sICAM-1可反映自身免疫性甲状腺疾病（AITD）患者体内的自身免疫状态，其测定对GD、HT有辅助诊断价值，这对于了解GD患者的自身免疫活动程度、预测GD眼病的发生和GD复发、确定合理的疗程和停药时机可能具有重要意义。

Objective Markedly elevated serum soluble intercelhdar adhesion molecule 1 （sICAM-1） level has recently been reported in patients with autoimmune thyroid disease （ARID）. The aim of this study was to investigate the clinical significance of slCAM-1 serum level in patients with different thyroid diseases. Metbors A total of 616 patients were recruited, consisting of 557 Graves＇ disease （GD）, 33 untreated Hashimoto＇s thyroiditis （HT）, 17 untreated simple goiter （SG） and 9 nontoxic nodular goiter （NTNG）. Control was a group of 273 healthy individuals with no prior history of thyroid disease. Their serum sICAM-1 levels were measured by ^125Ⅰ-slCAM-1 radioimmunoassay. If sICAM-1 levels of every group fit normal distribution, statistical difference was calculated by ANOVA or t-test; if not, then rank sum test （ Kruskal-Wallis or Mann-Whitney） was used. Results There was no statistically significant difference among the SG [ （ 173. 82 ±59. 50） ug/L], NTNG [ （ 159.31±28.73） ug/L] and control [ （ 149.89 ±39.45） ug/L] groups; whereas the levels in both untreated GD [ （255.04 ±82.40）ug/L] and HT [ （227.22 ±77.08） ug/L] groups were elevated and statistically significant by comparison with the control group （Z = -9.401, -5. 902, respectively; both with P 〈 0.01 ）. In each stage of antithyroid drugs （ATD） treatment, the serum sICAM-1 concentrations of GD patients with ophthalmopathy were higher than those without ophthalmopathy, however, only the group with ATD duration ≥19 months was found significant （t =2. 004, P 〈0.05）. The recurrent GD group had higher slCAM-1 levels than control group （X^2= 88. 257, P 〈0.01 ）. In stable euthyroid patients receiving ATD, a steady trend of gradual decline in slCAM-1 levels was found. When ATD treatment lasted ≥19 months, the slCAM-1 levels in GD patients with and without ophthalmopathy [ （211.58 ±53.58） ug/L and （189.50 ± 39.99 ） ug/L, respectively] were significantly decreased when compared with the corresponding pair of new-onset groups [ （287.36 ± 79.20） ug/L and （244.75 ± 81.58）ug/L, F = 9. 986, 3. 398, respectively;all P 〈 0.05 ] but remained persistently elevated over the control group even after stopping ATD treatment （Z = - 3. 813, P 〈 0.05）. Conclusions The slCAM-1 assay is of great importance in the diagnosis of AITD and detection of the associated abnormal immune status in these patients. It may help to monitor treatment effect, predict GD relapse and perhaps onset of ophthalmopathy, and determine the optimal duration of ATD treatment. Further studies are needed to investigate whether sICAM-1 could be used as a criterion for withdrawal of ATD treatment.