血清IL-10、CD4^(+)T淋巴细胞在自身免疫性甲状腺炎患者中的表达及临床意义

Expression and clinical significance of serum IL-10 and CD4^(+) T lymphocytes in patients with autoimmune thyroiditis

目的探讨血清白细胞介素-10(IL-10)、CD4^(+)T淋巴细胞在自身免疫性甲状腺炎患者中的表达及临床意义。方法回顾性选取2016年1月到2020年12月安徽医科大学附属宿州医院共收治的70例自身免疫性甲状腺炎患者作为研究对象,其中29例患者为Graves病,将其分为GD组;其余41例为桥本甲状腺炎,将其分HT组;另取同期来体检的50例健康者作为对照组。比较3组研究对象甲状腺功能指标[抗甲状腺微粒体抗体(TmAb)、甲状腺球蛋白抗体(TgAb)、促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)]检测结果、血清IL-10与CD4^(+)T淋巴细胞的表达水平;并进一步比较GD组与HT组不同缓解程度患者的甲状腺功能相关指标、血清IL-10与CD4^(+)T淋巴细胞水平差异,并进行相关性分析。结果(1)与对照组相比,HT组患者TmAb、TgAb、TSH、FT4、FT3水平均显著升高,差异均有统计学意义(P<0.05),GD组患者TSH水平显著降低,TmAb、TgAb、FT4、FT3水平显著升高,差异均有统计学意义(P<0.05)。与HT组相比,GD组患者TmAb和TSH显著降低,FT4和FT3水平显著升高,差异均有统计学意义(P<0.05)。(2)与对照组相比,HT组和GD组IL-10和CD4^(+)T淋巴细胞水平均显著降低,且HT组也显著低于GD组,差异均有统计学意义(P<0.05)。(3)HT缓解组、未缓解组和新发病组患者的TSH、FT4、TgAb、IL-10、CD4^(+)T淋巴细胞对比差异显著,具体趋势为FT4和IL-10:缓解组>未缓解组>新发病组,而其余3个指标趋势相反(P<0.05)。(4)GD缓解组、未缓解组和新发病组患者的TSH、FT4、FT3、IL-10对比差异显著,具体趋势为TSH:缓解组>未缓解组>新发病组,而其余3个指标趋势相反(P<0.05)。(5)Spearman相关分析结果显示:TSH与HT预后呈负相关(P<0.05),TgAb、FT4、IL-10、CD4^(+)T淋巴细胞与HT预后呈正相关(P<0.05),TmAb、FT3与HT预后无明显相关性(P>0.05);TSH与GDT预后呈负相关(P<0.05),TmAb、TgAb、CD4^(+)T淋巴细胞与GD预后无明显相关性(P>0.05),FT4、FT3、IL-10与GD预后呈正相关(P<0.05)。结论自身免疫性甲状腺炎患者的甲状腺患者存在甲状腺功能、IL-10和CD4^(+)T淋巴细胞异常现象,但是对不同自身免疫性甲状腺炎患者的预后判断中应用IL-10水平判断更为准确,对桥本甲状腺炎患者应用IL-10和CD4^(+)T淋巴细胞水平判断均比较准确。

Objective To investigate the expression and clinical significance of serum interleukin-10(IL-10)and T lymphocyte CD4^(+) in patients with autoimmune thyroiditis.Methods A total of 70 patients with autoimmune thyroid disease who were admitted to Suzhou Hospital of Anhui Medical University from January 2016 to December 2020 were retrospectively selected as the research objects,29 cases of Graves disease were divided into GD group,41 cases of Hashimoto thyroiditis were divided into HT group,and 50 healthy people who came to our hospital for physical examination at the same time were selected as the control group.Thyroid function indexes of 3 groups of study subjects[anti-thyroid microsomal antibody(TmAb),thyroglobulin antibody(TgAb),thyroid-stimulating hormone(TSH),free thyroxine(FT4),free triiodothyronine(FT3)]test results,serum IL-10 and CD4^(+) T lymphocyte expression levels of the three groups were compared;In addition,the differences in thyroid function-related indicators,serum IL-10 and CD4^(+) T lymphocyte levels in patients with different remission levels between the GD group and the HT group were further compared,and the correlation analysis was performed.Results(1)Compared with the control group,the levels of TmAb,TgAb,TSH,FT4,and FT3 in the HT group were significantly increased,and the differences were statistically significant(P<0.05).The TSH levels in the GD group was significantly reduced,and the levels of TmAb,TgAb,FT4,FT4,FT3 were significantly increased in the GD group,and the differences were statistically significant(P<0.05).Compared with the HT group,the TmAb and TSH of the GD group were significantly reduced,and the levels of FT4 and FT3 were significantly increased,and the differences were statistically significant(P<0.05).(2)Compared with the control group,the levels of IL-10 and CD4^(+) T lymphocytes in the HT group and the GD group were significantly reduced,and the levels of IL-10 and CD4^(+) T lymphocytes in the HT group was also significantly lower than that in the GD group(P<0.05).(3)The TSH,FT4,TgAb,IL-10,CD4^(+) T lymphocytes of the HT remission group,the non-remission group and the newly-onset patients were significantly different,and the specific trends were FT4 and IL-10:remission group>non-remission group>new-onset group,while the other three indicators had opposite trends(P<0.05).(4)There were significant differences in TSH,FT4,FT3,and IL-10 between the GD remission group,the non-remission group and the new-onset patients,and the specific trend was TSH:remission group>non-remission group>new-onset group,while the other three indicators had opposite trends(P<0.05);(5)Spearman correlation analysis results showed that TSH was negatively correlated with the prognosis of HT(P<0.05).There was a positive correlation between the prognosis of HT,FT4,IL-10,CD4^(+) T lymphocytes(P<0.05),but no significant correlation between TMAb and FT3(P>0.05);TSH was negatively correlated with the prognosis of GDT(P<0.05),TMAb,TGAb had no significant correlation with Gd prognosis(P>0.05),FT4,FT3,IL-10,CD4^(+) T lymphocytes were positively correlated with the prognosis of Gd(P<0.05).Conclusion thyroid function,IL-10 and CD4^(+) T lymphocytes are abnormal in patients with autoimmune thyroiditis,but the level of IL-10 and CD4^(+) T lymphocytes is more accurate in the prognosis judgment of patients with different autoimmune thyroiditis,which can be used as the related indicators of patient condition monitoring.