Graves病治疗前后甲状腺轴功能、自身抗体和细胞间黏附分子-1的变化  

Clinical study on the changes of several immunological indexes before and after treatment of Graves′ disease

作　　者：李宁[1] 柴锦燕[1] 董升[1] 王英姿[2] 孟召伟[1] 郑薇[1] 方佩华[1] 冯凭[2] 高硕[1] 谭建[1] LI Ning;CHAI Jin-yan;DONG Sheng;WANG Ying-zi;MENG Zhao-wei;ZHENG Wei;FANG Pei-hua;FENG Ping;GAO Shuo;TAN Jian(Department of Nuclear Medicine,General Hospital of Tianjin Medical University,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院核医学科,天津300052 [2]天津医科大学总医院内分泌代谢科,天津300052

出　　处：《广东医学》2019年第13期1851-1855,共5页Guangdong Medical Journal

基　　金：国家自然科学基金青年科学基金项目(编号:81601523);天津市科技发展计划项目(编号:05YFGDSF02700);天津市科技计划项目(编号:11ZCKFSY00300)

摘　　要：目的通过前瞻性临床试验观察Graves病(GD)患者抗甲状腺药物(ATD)系统治疗前后甲状腺轴功能、自身抗体和可溶性细胞间黏附分子-1(sICAM-1)的变化,探讨有效监测GD转归及预后的免疫学指标。方法初发GD患者134例,根据是否伴突眼分为突眼组(A组)和非突眼组(B组),A组根据早期是否加用强的松分为Aa、Ab亚组,B组根据后期是否加用左旋甲状腺素片分为Ba、Bb亚组。规范治疗2年以上逐渐减量停药后随访,观察治疗前、治疗后3~36个月患者甲状腺轴功能、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、甲状腺刺激性抗体(TSAb)和sICAM-1的变化规律。结果患者初诊年龄、sTSH、游离甲状腺素(FT4)、TSAb、sICAM-1是GD复发的主要影响因素。血清TSAb随疗程延长逐渐下降,至治疗12个月时显著低于治疗前(t=2.787,P<0.01),30个月时降低到与健康人无差异(t=1.031,P>0.05)。血清sICAM-1水平随疗程而缓慢下降,30个月后明显低于治疗前(χ2=46.420,P<0.01),36个月时与健康人无异(χ2=17.311,P>0.05)。TPOAb、TgAb水平均差异无统计学意义(P>0.05)。按转归分为缓解组与复发组,29例患者在24~36个月出现复发,总复发率为21.6%。复发组TSAb显著高于同期治疗缓解者(t=1.783、2.075、3.837,均P<0.05),复发组sICAM-1水平始终高于缓解组(P<0.05)。不同治疗组复发率分别为Aa 12.5%、Ab 38.5%、Ba 29.8%、Bb 10.0%,Bb组复发率显著低于其余三组(χ2=5.638,P=0.018)。Aa、Ab、Ba三组的复发率差异无统计学意义(P>0.05)。结论 GD患者血清TSAb、sICAM-1水平随疗程缓慢下降,明显晚于甲状腺功能恢复,sICAM-1水平恢复晚于TSAb,动态监测血清TSAb和sICAM-1变化,可以作为ATD疗效评价指标。ATD治疗至少应坚持sICAM-1水平恢复正常即治疗30月以上,才能有效降低复发率。Objective To investigate the effect of different anti-thyroid agents on thyroid autoantibodies by prospective study and to find the effective and specific method to deal with Graves′ disease(GD). Methods A total of 134 patients with initial GD were divided into a group of exophthalmos(Group A) and a non-exo group(Group B) according to whether or not complicated with exophthalmos. Group A was divided into Aa and Ab subgroups according to whether early addition use of prednisone. The Group B was divided into Ba and Bb subgroups according to whether or not use of levothyroxine. The changes of thyroid function, TPOAb, TgAb, TSAb and sICAM-1 were observed before treatment, and 3 months, 6 months, 12 months, 18 months, 24 months, 30 months and 36 months after treatment.Results The age of initial diagnosis, sTSH, FT4, TSAb, and ICAM-1 were the main influencing factors of GD recurrence. Serum TSAb decreased gradually with the prolongation of treatment, which was significantly lower 12 months after treatment than that before treatment(t=2.787, P<0.01), and recovered to normal 30 months after treatment(t=1.031, P>0.05). The serum sICAM-1 level decreased slowly with the course of treatment. After 30 months, it was significantly lower than that before treatment(χ~2=46.420, P<0.01). After 36 months, there was no significant difference from healthy people(χ~2=17.311, P>0.05). There was no statistical difference in TPOAb and TgAb levels between the 2 groups. Twenty-nine patients had recurrence between 24-36 months, with a total recurrence rate of 21.6%. The TSAb in the recurrent group was significantly higher than those in remission group in the same period(t=1.783, 2.075, 3.837, P<0.05). The level of sICAM-1 in the recurrent group was significantly higher than that in the remission group(P<0.05). The recurrence rates of Group Aa, Ab, Ba and Bb were 12.5%, 38.5%, 29.8% and 10%, respectively;and the recurrence rate of Group Bb was significantly lower than the other three groups(χ~2=5.638, P=0.018). There was no significant

关 键 词：GRAVES病 甲状腺抗体 抗甲状腺药物 可溶性细胞间黏附分子 

分 类 号：R581[医药卫生—内分泌] R96[医药卫生—内科学]