甲状腺局部注射地塞米松治疗Graves病中调节性T细胞变化的研究  

The changes of regulatory T cells in intrathyroid injection treatment with dexamethasone against Graves disease

作　　者：何珂[1] 胡蕴[1] 毛晓明[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)内分泌科,210012

出　　处：《免疫学杂志》2013年第9期787-791,共5页Immunological Journal

基　　金：南京市医学科技发展项目(ZKX12023)

摘　　要：目的观察地塞米松甲状腺局部注射治疗Graves病(Graves disease,GD)对外周血Treg细胞功能、Th1及Th2细胞平衡的影响,阐明地塞米松治疗GD的机制。方法 28例抗甲状腺药物治疗维持期的GD患者,甲状腺局部注射地塞米松,治疗前后分别检测血清游离甲状腺功能、抗甲状腺抗体水平,彩色多普勒甲状腺超声测量甲状腺体积变化;流式细胞仪检测外周血T细胞亚群数量变化;提取外周血单个核细胞用磁珠分离法分离Treg细胞(CD4+CD25+)及CD4+CD25-T淋巴细胞原代细胞培养,流式细胞仪检测T细胞增殖率,计算T细胞抑制率,反映Treg细胞抑制功能。结果 1)甲状腺局部注射地塞米松后,游离甲状腺功能无显著差异(P>0.05),抗甲状腺抗体水平均降低(P<0.01),甲状腺体积减小(P<0.01)。2)GD患者外周血中Treg细胞增多(P<0.05),Th2细胞减少(P<0.05),Th1细胞无明显变化(P>0.05)。3)Treg细胞抑制功能增强(P<0.05)。结论甲状腺局部注射地塞米松能有效改善GD患者外周血Treg细胞功能,重建Th1/Th2细胞平衡,降低甲状腺抗体水平,减小肿大的甲状腺体积,是治疗GD的有效方法。This study was designed to investigate the immune mechanism of intrathyroid injection treatment with dexamethasone against Graves disease（GD） through in vivo observation of the function of regulatory T（Treg） cells and the balance between Th1 and Th2 cells before and after the treatment.Total of 28 GD patients in the maintenance period of antithyroid drugs underwent the intrathyroid injection treatment of dexamethasone.Serum TSH,FT3,FT4,TRAb,TPOAb and TGAb levels were detected and thyroid volumes were calculated after the measurement by color Doppler ultrasound;the amount of different T cells subsets in peripheral blood were measured by flow cytometry.T cells were divided into Treg（CD4＋CD25＋）cells and CD4＋CD25-T cells using magnetic bead separation column for primary cell culture,and then the T cells were labeled by CFSE and the proliferation rate was measured by flow cytometry,and the inhibition rate was calculated to reflect the function of Treg cells.We found that there were no significant differences of TSH,FT3 and FT4 before and after the treatment,while the levels of TRAb,TPOAb and TGAb were reduced obviously,and the thyroid volumes were also decreased after the treatment.After the treatment,the percentage of Treg cells increased,Th2 cells decreased,but Th1 cells had no significant change.Furthermore,the function of Treg cells was up regulated after the dexamethasone therapy.The results suggested that intrathyroid injection treatment of dexamethasone against GD is able to improve the function of Treg cells and rebalance Th1/Th2 cells,reduce the levels of thyroid antibodies,and decrease the thyroid volumes,thus can be a new and effective treatment of GD.

关 键 词：GRAVES病 地塞米松 甲状腺局部注射 调节性T细胞 

分 类 号：R581.1[医药卫生—内分泌] R392.6[医药卫生—内科学]