不同治疗方法对Graves病患者外周血淋巴细胞亚群的影响  

Effects of different therapeutic methods on peripheral blood lymphocyte subgroups in patients with Graves＇ disease

作　　者：赵永强[1] 田德增[1] 魏晓华[1] 陈瑞锋[2] 王升[3] 陈贵存 高用琴[1] 王利强[5] 

机构地区：[1]河南省安阳地区医院内分泌科,455000 [2]河南省安阳地区医院心内科,455000 [3]河南省安阳地区医院临床试验室,455000 [4]河南省安阳地区医院输血科,455000 [5]河南省安阳地区医院核医学科,455000

出　　处：《国际内分泌代谢杂志》2015年第4期234-237,241,共5页International Journal of Endocrinology and Metabolism

摘　　要：目的探讨抗甲状腺药物、131I、外科手术对Graves病患者外周血淋巴细胞亚群的影响。方法选取106例符合Graves病诊断的门诊及住院患者，根据患者实际情况分为抗甲状腺药物组（39例）、131I治疗组（48例）、甲状腺次全切除术组（19例），于治疗前及治疗后3、6、12个月采用化学发光免疫仪检测游离T3、游离T4、促甲状腺激素（TSH）水平。电化学发光仪检测TSH受体抗体（TRAb）。流式细胞术检测CD3＋,CD3＋CD4＋．CD3＋CD8＋、CD3／（CD16＋CD56＋）、CD3-CD19＋等水平。结果治疗后3个月，与其他两组相比，甲状腺次全切除术组游离B、游离T4、TRAb水平降低，TSH水平升高（F=52．95—126．81，P均〈0．05）。治疗后6个月，131I治疗组与抗甲状腺药物组相比，游离B水平有降低趋势，但无统计学意义（P〉0．05），游离T4、TSH无明显差异（P均〉0．05），而TRAb水平的变化有统计学意义（F=42．69，P〈0．05）。治疗后12个月，各治疗组游离B、游离T4、TSH、TRAb趋向正常水平。治疗前，3组患者CD3＋、CD3＋CD4＋,CD3＋CD8＋、CD4VCD8＋,CD3／（CD16＋CD56＋）、CD3-CD19＋的差异无统计学意义。治疗后各时间点，与其他两组相比，甲状腺次全切除术组CD3＋、CD3＋CD4＋、CD3＋CD8＋、CD4＋／CD8＋水平均最低（F=3．48—68．28，P均〈0．05）；与抗甲状腺药物组相比，治疗3个月后，131I治疗组CD3＋、CD3＋CD4＋、CD3＋CD8＋、CD4＋／CD8＋、CD3-CD19＋明显升高（F=13．85—68．28，P均〈0．05），随着治疗时间的延长各指标逐渐降低。相关性分析表明，游离B、游离T4、TRAb与CD3＋（r=0．319，0．402，0．426，P均〈0．01）、CD3＋CD4＋（r：0．467，0．526，0．453，P均〈0．01）、CD3-CD19＋（r=O．493，0．462，0241，P〈0．01）呈正相关，与CD3＋CD8＋（r=-0．422，-0．523，-0．344，P均〈0．01）、CD3（CD16＋CD56＋）（r=-0．597，Objective To explore the influences of anti-thyroid drug , 131I and surgery on peripheral blood lymphocyte subgroups in patients with Graves＇ disease. Methods A total of 106 inpatients and outpa- tients with Graves＇ disease were included. According to their therapeutic method of Graves＇ disease,patients were divided into 3 groups： 39 patients in anti-thyroid drug therapy group, 48 patients in 131I therapy group, 19 patients in surgery therapy group. Before and 3,6,12 months after treatment,free T3, free T4, and thyroid stimulating hormone （TSH） were tested by chemiluminescence immunoassay, TSH receptor antibody（TRAb） was tested by electro-chemiluminescence immunoassay and CD3＋,CD3＋CD4＋,CD3＋CD8＋,CD3J（CD16＋CD56＋）, CD3-CD19＋ were tested by flow cytometry. Results After treatment for 3 months,compared with anti-thyroid drug therapy group and 1311 therapy group, levels of free T3, free T4, TRAb in surgery therapy group were decreased, but level of TSH was increased （F =52.95-126.81, all P〈0.05）. After treatment for 6 months, compared with anti-thyroid drug therapy group,levels of free T3 in 131I therapy group was decreased,although without statistical significance（P 〉0.05 ） ;level of free T4 and TSH had no significance （all P 〉 0.05 ）, whereas TRAb was different （F =42.69,P〈0.05 ）. After treatment for 12 months, free T3, free T4, TSH and TRAb in three groups were gradually returned to normal. Before treatment, there were no differences of CD3＋, CD3＋CD4＋, CD3＋CD8＋, CD4＋/CD8＋, CD3/（CD16＋CD56＋）, CD3-CD19＋ between the three groups. After treatment, the levels of CD3＋,CD3＋ CD4＋, CD3＋CD8＋,CD4＋/CDS＋ in surgery therapy group were lower than those in other groups （F =3.48-68.28, all P〈0.05）. After treatment for 3 months, compared with anti-thyroid drug therapy group, CD3＋, CD3＋CD4＋, CD3＋CD8＋, CD4＋/CD8＋, CD3-CD19＋ in 131I therapy group were increased greatly （F =13.85-68.28, all P〈0.05）. However, all tho

关 键 词：GRAVES病 甲状腺功能 淋巴细胞亚群 

分 类 号：R392.12[医药卫生—免疫学]