摘要
目的：探讨免疫抑制剂静脉冲击治疗Graves病相关性眼病（GO）的疗效与外周血T淋巴细胞亚群变化的关系。方法：GO患者58例，随机平均分为2组（n=29），所有患者口服常规抗甲状腺药物和（或）左旋甲状腺素片替代治疗，同时接受含甲泼尼龙0．5g的生理盐水250ml及含环磷酰胺0．2g的生理盐水500ml静滴，1次／d，连用3d，间隔4d重复用，共3～6个疗程。A组在冲击治疗结束后口服泼尼松片和环磷酰胺片，B组在冲击治疗后甲状腺内注射地塞米松磷酸钠注射液。结果：A组中2例退出，B组中1例退出，B组的疗效好于A组（P〈0．05）。两组治疗后突眼度、突眼活动度、促甲状腺素受体抗体（TRAb）、过氧化物酶抗体（TPOAb）、外周血NK细胞、CD3^＋T淋巴细胞、CD8^＋T淋巴细胞较治疗前明显减少（P〈0．05），CD4^＋／CD8^＋比值较治疗前升高（P〈0．05）；B组治疗后突眼度及突眼活动度、CD3^＋、CD8^＋T淋巴细胞较A组降低更显著（P〈0．05），CD4^-／CD8^-比值增高较A组更显著（P〈0．05）。治疗前CD4^＋T淋巴细胞在显效组、有效组、无效组间存在显著性差异（P〈0．05）；3组中治疗后的TRAb、TPOAb、CD3^＋、CD8^＋T淋巴细胞较治疗前显著减少（P〈0．05），CD4^＋T淋巴细胞、CD4^＋／CD8^＋比值治疗后较治疗前显著升高（P〈0．05）；治疗后TRAb、CD4^＋、CD8^＋T淋巴细胞、CD4^＋／CD8^＋在3组间存在显著性差异（P〈0．05）。结论：甲泼尼龙联合环磷酰胺静脉冲击治疗GO能缓解失调的外周血T淋巴细胞，疗效明显，冲击治疗后甲状腺内注射地塞米松疗效更佳；GO的外周血CD4^＋T淋巴细胞降低可能预示疗效不良。
Objective： To study the association between the outcomes of intravenous pulse-therapy with immunosuppressants and the changes of peripheral blood T cell subgroup in patients with Graves＇ ophthalmopathy （GO）. Methods： Fifty-eight patients with GO were randomized into 2 groups （n=29）. All patients received antithyroid drugs orally and （or） Levothyroxine; they also received intravenous meprednisone （0.5 g） and cyclophosphamide（0.2 g） once a day for 3 days. After an interval of 4 days the administration of meprednisone and cyclophosphamide was repeated. All patients received a total of 3-6 times of treatment. Patients in group A were given prednisone and cyclophosphamide orally after immunosuppressants. Patients in group B were injected with Dexamethasone into thyroid after immunosuppressants. Results： Two patients withdrew from group A and one from group B. The therapeutic effect in group B was significantly better than that in group A （P〈0.05）. Compared with before treatment, the degrees of exophthalmos and exophthalmos activity were significantly lowered after treatment （P〈0.05）; the thyrotropin receptor antibodies （TRAb） ,thyroid peroxidase （TPOAb）,peripheral blood NK cells, CD3^＋ T lymphocytes,and CD8^＋T lymphocytes were significantly reduced after treatment （P〈0.05） ;the ratio of CD4^＋/CD8^＋ was increased after the treatment （P〈0. 05）. The degrees of exophthalmos, exophthalmos activity and levels of CD3^＋ T lymphocytes decreased more significantly in group B than in group A（P〈0. 05）. The ratio of CD4^＋/CD8^＋ increased more significantly in group B than in group A（P〈0.05）. Before treatment the counts of CD4^＋ T lymphocytes were markedly different between the effective, moderately effective, and the ineffective group （P〈0. 05）. Significant differences in TRAb, TPOAb, CD3^＋ ,CD8^＋ cells were found among the 3 groups after treatment. （P〈0. 05）. CD4^＋ T lymphocytes and CD4^＋/CD8^＋ ratio were significantly higher after treatment compared with those before treatment （P〈0. 05）. Significant differences in TRAb, CD4^＋,CD8^＋ T lymphocytes, CD4^-/CD8^- ratio were found among 3 groups （P〈0. 05）. Conclusion： Combination of meprednison and cyclophosphamide can relieve the abnormality of peripheral blood T cells in GO and has obvious therapeutic effect. Additional intrathyroid injection of dexamethasone may achieve even better outcome. The reduction of CD4^＋ T lymphocytes in peripheral blood of GO patients may indicate poor prognsis.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2008年第8期944-948,共5页
Academic Journal of Second Military Medical University
