小剂量甲泼尼龙联合甲巯咪唑治疗Graves病疗效及对患者T淋巴细胞亚群的影响

Curative Effect of Low-dose Methylprednisolone Combined with Methimazole on Graves’Disease and Its Influence on T Lymphocyte Subsets

目的:观察小剂量甲泼尼龙联合甲巯咪唑对Graves病的疗效,及对患者T淋巴细胞亚群的影响。方法:132例Graves病患者随机分为观察组和对照组各66例。对照组给予甲巯咪唑治疗,观察组在对照组基础上加用小剂量甲泼尼龙。治疗6个月后,比较两组治疗总有效率、治疗前后患者临床症状变化(甲状腺体积、眼球突出度)、甲状腺功能[血清游离三碘腺原氨酸(FT_(3))、血清游离甲状腺素(FT_(4))、超敏促甲状腺激素(sTSH)]、血清炎性因子水平[肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、内脂素(visfatin)]及T淋巴细胞亚群[辅助性T淋巴细胞(CD4^(+))、抑制性T淋巴细胞(CD8^(+))和CD4^(+)/CD8^(+)]及不良反应发生情况。结果:治疗后,观察组总有效率为93.94%,明显高于对照组的69.70%(P<0.05)。治疗后,两组患者的sTSH水平和CD4^(+)、CD4^(+)/CD8^(+)均较治疗前明显升高,甲状腺体积、眼球突出度、FT_(3)、FT_(4)、TNF-α、IL-6、visfatin水平和CD8^(+)则较前明显降低(P<0.05);且观察组上述各项指标均明显优于对照组(P<0.05)。两组药品不良反应发生率(7.58%vs.12.12%)差异无统计学意义(P>0.05)。结论:小剂量甲泼尼龙联合甲巯咪唑治疗Graves病效果较好,可有效减轻临床症状,降低血清炎性因子水平,改善甲状腺功能及T淋巴细胞亚群,同时安全性较好,具有一定临床推广使用价值。

Objective:To observe the therapeutic effect of low-dose methylprednisolone combined with methimazole on toxic diffuse goiter(Graves’disease)and analyze its effect on T lymphocyte subsets.Methods:A total of 132 patients with Graves’disease were divided into observation group and control group at random with 66 cases in each group.The control group was treated with methimazole,and the observation group was treated with methylprednisolone on the basis of the control group.The total effective rate,clinical symptoms(thyroid volume,degree of exophthalmos),thyroid function[serum free triiodothyronine(FT_(3)),serum free thyroxine(FT_(4)),super sensitive thyrotropin(sTSH)],serum inflammatory factors levels[tumor necrosis factor(TNF-α),interleukin-6(IL-6),visfatin],T lymphocyte subsets[T helper cells(CD4^(+)),suppressor T cell(CD8^(+)),CD4^(+)/CD8^(+)]and incidence of adverse reactions were compared between the two groups.Results:The total effective rate of the observation group was 93.94%,which was significantly higher than that(69.70%)of the control group(P<0.05).After treatment,the levels of sTSH,CD4^(+)and CD4^(+)/CD8^(+)in the two groups were significantly higher than those before treatment(P<0.05),and those in the observation group were significantly higher than those in the control group(P<0.05);the thyroid volume,degree of exophthalmos,FT_(3),FT_(4),TNF-α,IL-6,visfatin and CD8^(+)levels in the two groups were significantly lower than those before treatment(P<0.05),and those in the observation group were significantly lower than those in the control group(P<0.05);there was no statistical significance in the incidence of ADRs between the two groups(7.58%vs.12.12%)(P>0.05).Conclusion:Low-dose methylprednisolone combined with methimazole is effective in the treatment of Graves’disease.It can effectively reduce the clinical symptoms,reduce the levels of serum inflammatory factors,and improve the thyroid function and T-lymphocyte subsets with promising safety,which has certain clinical application values.