甲强龙静脉冲击治疗Graves眼病对免疫球蛋白及CD系列的影响  

Changes of immunoglobulins and CD series in patients with Graves′ orbitopathy treated with high-dose methylprednisolone

作　　者：布阿提卡木·阿布都克日木 李琴[1] 王宁荐[1] 夏芳珍[1] 陈奕[1] 陈小曼 朱春芳[1] 乔洁[1] 朱凡凡 陆颖理[1] Buatikamu Abudukerimu;Li Qin;Wang Ningjian;Xia Fangzhen;Chen Yi;Chen Xiaoman;Zhu Chunfang;Qiao Jie;Zhu Fanfan;Lu Yingli(Department of Endocrinology and Metabolism,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院内分泌与代谢科,200011

出　　处：《中华内分泌代谢杂志》2019年第9期756-760,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然基金青年科学基金项目(81800694);上海市领军人才计划(2015-048);上海卫计委课题(20184Y0233)。

摘　　要：目的研究甲强龙静脉冲击治疗中重度活动期Graves眼病(Graves’ orbitopathy)对免疫球蛋白及CD系列的影响。方法纳入2016年12月至2018年12月上海交通大学医学院附属第九人民医院住院,并根据2016年欧洲Graves眼病专家组(EUGOGO)联合欧洲甲状腺协会发布的Graves眼病管理指南接受甲强龙静脉冲击治疗12周方案的27例患者,分别于治疗前、治疗4周后及治疗12周后评估外周血促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)等甲状腺相关抗体,IgG、IgE、IgA、IgM等外周血总免疫球蛋白及CD3^+ T细胞、CD4^+ T细胞、CD8^+ T细胞、CD19^+ B细胞、CD16^+或CD56^+NK细胞等多种细胞百分比的变化情况。结果外周血TRAb、TPOAb等甲状腺相关抗体及总IgE、IgG、IgA等免疫球蛋白于治疗4周及12周后均显著下降(均P<0.05)。外周血CD3+T细胞百分比、CD4^+T细胞百分比以及CD4^+/CD8^+比值等在治疗4周后无明显变化(P>0.05),而治疗12周后均明显下降(P<0.05);CD8^+T细胞百分比无明显变化(P>0.05)。结论甲强龙可能通过调节体液免疫、细胞免疫及降低血清免疫球蛋白浓度等多种途径发挥治疗作用。Objective To study the effect of high-dose methylprednisolone intravenous pulse therapy on immunoglobulins and CD series in patients with active moderate-to-severe Graves′ orbitopathy.Methods Twenty-seven patients with active moderate-to-severe Graves′orbitopathy were enrolled in this study. All the patients received iv methylprednisolone pulse therapy for 12 weeks according to the 2016 European Thyroid Association/European Group on Graves′Orbitopathy(EUGOGO) Guidelines. Serum thyroidal autoantibodies, such as thyroid-stimulating hormone receptor antibody (TRAb), anti-thyroperoxidase antibody (TPOAb), and serum immunoglobulins, such as IgG, IgE, IgA, IgM were evaluated at the baseline, at the end of 4th and 12th week. Percentages of CD3^+ T cells, CD4^+ T cells, CD8^+ T cells and CD19^+ B cells, CD16^+ or CD56^+ NK cells were also evaluated at each time point.Results TRAb, TPOA and IgE, IgG, IgA were significantly decreased both after 4th week and after 12th week (all P<0.05). Percentages of CD3^+ T cells, CD4^+ T cells and CD4^+ /CD8^+ ratio were gradually decreased after treatment. However, change of CD8^+ T cells was not significant (P>0.05).Conclusion High-dose methylprednisolone may exert an immunosuppressive effect not only by modifying humoral and cellular immune functions, but also by decreasing serum immunoglobulins.

关 键 词：GRAVES眼病 甲强龙 冲击治疗 免疫球蛋白 CD系列 

分 类 号：R58[医药卫生—内分泌]