地塞米松联合甲状腺素钠治疗对自身免疫性甲状腺炎患者相关血清细胞因子、Th1/Th2相关细胞因子的影响  

The effect of dexamethasone combined with thyroxine in the treatment of autoimmune thyroiditis and its effect on the related serum cytokines and Th1/Th2 related cytokines

作　　者：崇显瑾 余青原 阿曼古丽.苏力唐 米娜[1] 李永桂 CHONG Xianjin;YU Qingyuan;Aman Guli·Suli Tang;MI Na;LI Yonggui(Department of Endocrinology,Qinghai People's Hospital,Xining 810002,China)

机构地区：[1]青海省人民医院内分泌科,西宁810002

出　　处：《疑难病杂志》2018年第11期1233-1237,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：青海省科技厅科技计划项目(2014-SF-530)

摘　　要：目的观察地塞米松联合甲状腺素钠治疗对自身免疫性甲状腺炎患者相关血清细胞因子、Th1/Th2相关细胞因子的影响。方法选择2016年3月—2017年3月青海省人民医院内分泌科收治的桥本甲状腺炎患者200例作为研究对象,随机数字表法分为观察组和对照组每组100例。对照组患者甲状腺素钠口服,观察组患者在对照组治疗基础上另加地塞米松注射治疗,比较2组患者治疗前后血清白介素-1(IL-l)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平,以及Th1/Th2相关细胞因子干扰素-γ(INF-γ)、白介素-10 (IL-10)基因表达的差异,观察2组患者治疗前后的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)及血清甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)的变化。结果与对照组治疗6月后相比,观察组患者的血清TNF-α、IL-l、IL-6以及IL-8水平明显降低(t/P=10. 550/0. 000,10. 022/0. 000,6. 469/0. 000,10. 745/0. 000); IL-10 mRNA表达水平明显升高(t/P=10. 679/0. 000),INF-γmRNA表达水平明显降低(t/P=11. 300/0. 000);血清FT3和FT4水平明显升高(t/P=3. 424/0. 000,5. 538/0. 000),血清TSH水平明显降低(t/P=4. 890/0. 000);血清TPOAb和TGAb水平均明显降低,差异显著具有统计学意义(t/P=6. 614/0. 000,14. 892/0. 000)。结论地塞米松联合甲状腺素钠治疗自身免疫性甲状腺炎可以显著降低TNF-α、IL-l、IL-6以及IL-8炎性因子水平,维持TH1/TH2细胞因子平衡,改善患者血清垂体甲状腺轴激素以及甲状腺自身抗体水平,疗效显著。Objective To observe the effect of dexamethasone combined with thyroxine sodium on serum cytokines and Th1/Th2 cytokines in patients with autoimmune thyroiditis and provide reference for clinical treatment of autoimmune thyroiditis.Methods From March 2016 to March 2017,200 patients with Hashimoto's thyroiditis who were admitted to the Department of Endocrinology of People's Hospital of Qinghai Province were selected as study subjects.They were randomly divided into observation group and control group with 100 cases in each group.The control group was treated with thyroxine sodium.The patients in the observation group were treated with dexamethasone injection on the basis of the control group.The differences of serum IL-l,IL-6,IL-8,TNF-αand Th1/Th2 related cytokines before and after treatment were compared between the 2 groups.The changes of serum FT 3,FT 4,STSH,TPOAb and TGAb were observed before and after treatment in the 2 groups.Results Compared with the control group after June,the serum levels of TNF-α,IL-l,IL-6 and IL-8 in the observation group were significantly lower(t/P=10.550/<0.01,t/P=10.022/<0.01,t/P=6.469/<0.01,t/P=10.745/<0.01),and the expression level of IL-10 mRNA increased significantly(t/P=10.679/<0.01),and the level of INF-γexpression was significantly reduced(t/P=11.300/0.000).The level of serum FT 3 and FT 4 increased significantly(t/P=3.424/0.000,t/P=5.538/<0.01),and the level of serum STSH decreased significantly(t/P=4.890/<0.01),and the level of serum TPOAb and TGAb decreased significantly,and the difference was statistically significant(t/P=6.614/<0.01,t/P=14.892/<0.01).Conclusion Treatment with dexamethasone and thyroxine sodium can significantly decrease the levels of TNF-α,IL-1,IL-6 and IL-8,maintain the balance of TH1/TH2 cytokines,and improve the serum pituitary Thyroid axis hormones and thyroid auto-antibodies,the effect is significant.

关 键 词：地塞米松 甲状腺素钠 自身免疫性甲状腺炎 TH1/TH2细胞因子 

分 类 号：R581.4[医药卫生—内分泌]