Graves病肝损害与甲状腺功能及免疫因素的关系

Relationship of Graves with hepatic injury and thyroid function and immune factors

目的探讨体液免疫因素、细胞免疫因素及甲状腺激素水平与Graves病肝功能损害的关系。方法回顾分析广西科技大学第一附属医院和广西壮族自治区柳州市人民医院于2009年1月~2013年6月收治的Graves病患者86例,其中,合并肝损害组40例（A组）,无肝损害组46例（B组）,设健康对照组30名,比较游离三碘甲状腺原氨酸（FT_3）、游离甲状腺素（FT_4）、总三碘甲状腺原氨酸（TT_3）、总甲状腺素（TT_4）、甲状腺过氧化物酶抗体（TPOAb）、促甲状腺素受体抗体（TRAb）、甲状腺球蛋白抗体（TGAb）、甲状腺微粒体抗体（TMAb）、免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、补体C3、C4、CD4、CD8、CD4/CD8比值。结果 A组与B组甲状腺功能比较,A组FT_3、FT_4、TT_3、TT_4增高,差异有高度统计学意义（P〈0.01）;A组及B组分别与健康对照组比较,FT_3、FT_4、TT_3、TT_4增高,差异有高度统计学意义（P〈0.01）。A组与B组体液免疫指标比较,TPOAb、TGAb、TMAb、TRAb、IgA、IgG、IgM增高,补体C3下降,差异有高度统计学意义（P〈0.01）;A组及B组分别与健康对照组比较,体液免疫指标差异均有高度统计学意义（P〈0.01）。A组与B组细胞免疫指标比较,CD4细胞增高,CD8细胞减少,CD4/CD8比值增高,差异有高度统计学意义（P〈0.01）;A组及B组分别与健康对照组比较,细胞免疫指标差异有高度统计学意义（P〈0.01）。结论甲状腺激素水平、体液免疫因素、细胞免疫因素与Graves病肝损害的发生发展有关。

Objective To investigate the relationship of humoral immunity, cellular immunity, thyroid hormones and Graves disease with hepatic injury. Methods The subjects included 86 patients with hyperthyroidism（caused by Graves disease） in the First Affiliated Hospital of Guangxi University of Science and Technology and Liuzhou People＇s Hospital from January 2009 to June 2013. They were divided into two groups： hepatic dysfunction group（group A, 40 patients）,normal hepatic function group（group B, 46 patients）, and 30 healthy donors as control group. The free three triiodothyronine（FT_3）, free thyroxine（FT_4）, total three triiodothyronine（TT_3）, total thyroxine（TT_4）, thyroid peroxidase antibody（TPOAb）, thyrotropin receptor antibody（TRAb）, thyroglobulin antibody（TGAb）, thyroid microsome antibody（TMAb）, immunoglobulin A（IgA）, immunoglobulin G（IgG）, immunoglobulin M（IgM）, complement C3, C4 and CD4,CD8, CD4/CD8 ratio were analyzed to examine the effect of thyroid hormones and immune factors on hepatic function.Results The levels of thyroid hormones（FT_3, FT_4, TT_3, TT_4） of group A were significantly higher than those of group B（P〈0.01）, and the levels of thyroid hormones of group A and group B were significant higher than those of the control group respectively（P〈0.01）. The levels of humoral immune index（TPOAb, TGAb, TMAb, TRAb, IgA, IgG, IgM） of group A were significant higher than those of group B（P〈0.01）, the level of C3 of group A was lower than group B（P〈0.01）. The humoral immune index of group A and group B were compared with the control group respectively, the differences were statistically significant（P〈0.01）. The results of cellular immune index（CD4, CD8 and CD4/CD8 ratio） showed that, the number of CD4 cells and CD4/CD8 ratio of group A were significant higher than those of group B（P〈0.01）, however, the number of CD8 cells of group A was lower than that of group B（P〈0.01）. The cellular immune index of group A and group B were compared with the control group respectively, the differences were statistically significant（P〈0.01）. Conclusion The occurrence and severity of thyrotoxic hepatic lesion are correlated with humoral immunity, cellular immunity and the level of thyroid hormones.