不同碘摄入量对Graves病自身免疫的影响

The effects of different amounts of iodine intake on the immune status of patients with Graves disease

目的探讨不同碘摄入量对Graves病（GD）患者体内细胞免疫、体液免疫的影响。方法对甲状腺细针细胞学检查诊断为GD的患者，依据尿碘中位数（MUI）489．5μg/L分为GDⅠ组（高于MUI）与GDⅡ组（低于MUI），分别对其进行游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、促甲状腺素（TSH）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）、甲状腺激素受体抗体（TRAb）、肿瘤坏死因子（TNF-α）联合测定。分析两组各指标的差异及相关性。结果GDⅠ组TRAb高于GDⅡ组[分别为（1．4±0．2）、（1．2±0．1）U／L，t=5．62，P〈0．05]；GDI组TPOAb、TGAb阳性率（分别为84．2％、78．9％）高于GDⅡ组（62．5％、50．0％）（χ^2值分别为4．71、7．10，P〈0．05，P〈0．01），且GDⅠ组TPOAb、TGAb高滴度组所占百分比高于GDⅡ组（χ^2值分别为6．79、10．70，P均〈0．05）。相关分析显示，TNF—α与TRAb、TPOAb呈直线正相关（r值分别为0．489、0．563，P均〈0．01）。结论高碘摄入加重GD患者的自身免疫，应限制GD患者的摄碘量。

Objective To investigate the effects of different amounts of iodine intake on the cellular and humoral immune in Grave＇s disease （GD） patients. Methods The clinical GD cases were diagnosed by thyroid fine needle Cytology examination. Patients in GD group are divided into GD group Ⅰ and GD group Ⅱbased on the median of urine iodine. The blood levels of FT4, FT3, TSH, TPOAb, TGAb, TRAb and TNF-α were detected. The difference and association of these parameters between these groups were analyzed. Results The TNF-α level in GD I group was higher than that of GD Ⅱ group（P 〉 0. 05 ） ; The average level of TRAb of GD Ⅰ group （ [ 1.4 ± 0. 2 ] U/L） were higher than that of GD Ⅱ group （ [ 1.2 ± 0.1 ] U/L） （ P 〈 0. 05 ） ; The positive rates of TGAb and TPOAb of GD Ⅰgroup were higher than that of GDⅡ group （ P 〈 0. 05 ）. The percentages of patients with high level of TGAb and TPOAb in GD Ⅰ group （78.9% ,84. 2% ）were higher than that in GD Ⅱ group （50. 0% ,62. 5% ） （χ^2 =-6. 79,10. 70,P 〈0. 05） ; Analysis showed a linear positive correlation of TNF- α with TRAb and TPOAb （r is 0. 489 and 0. 563 ,P 〈 0. 01 ）. Condusion Iodine is an important factor to the development of Graves disease. Excessive iodine intake will exaggerate the GD condition and patients with GD should be controlled for iodine intake.