131I对Graves病外周血粒细胞集落刺激因子和白细胞的影响

目的 探讨¹³¹I治疗Graves病(GD)对患者外周血粒细胞集落刺激因子(G-CSF)和白细胞的影响。方法 采用酶联免疫吸附试验(ELISA)、Coulter 3分类血细胞分析和放射免疫分析法(RIA),分别检测初发43例白细胞正常和22例白细胞减少的GD患者于¹³¹I治疗前及治疗后30、90和180 ｄ血清G-CSF水平、白细胞总数和甲状腺激素水平,并进行相关性分析。30例年龄与性别相匹配的健康者作为健康对照。结果 GD患者中白细胞正常组血清G-CSF水平(28.4±11.7)μg/L显著高于健康对照组(18.3±6.98)μg/L (t=2.376,P<0.05);白细胞减少组血清G-CSF水平(40.1±13.8)μg/L升高(t=3.672,P<0.01);¹³¹I治疗180 ｄ后,甲状腺功能恢复正常,症状缓解,血清G-CSF水平逐渐下降,但白细胞减少组(25.7±11.5) μg/L仍高于健康对照组(t=2.103,P<0.05);GD患者G-CSF与白细胞呈负相关(r=-0.38,P<0.05),与FT₃、FT₄、TSH没有相关性。 结论 GD患者体内存在G-CSF异常表达,可能与白细胞减少有关;¹³¹I治疗能有效抑制GD患者自身免疫,可能是治疗伴白细胞减少GD患者一种安全可靠、疗效显著的方法,宜尽早选用。

Effects of 131I treatment on the circulating granulocyte colony-stimulating factor and leucocyte levels in patients with Graves' disease

Objective To observe the effects of 131I treatment on circulating granulocyte colonystimulating factor (G-CSF) and leucocyte levels of patients with Graves' disease (GD).Methods Enzyme-linked immunosorbent assay (ELISA),coulter three assortments,and radioimmunoassay were used to test the levels of circulating G-CSF,leucocytes and thyroid hormones of 65 incipient and untreated GD patients,all females,aged 21 -50,43 with normal leucocyte level and 22 with leucopenia before and after 131I treatment.Thirty age-matched healthy female subjects were used as controls.Results Before 131I treatment,the serous G-CSF level of the GD patients with normal leucocyte level was (28.4 ± 11.7)μg/L,significantly higher than that of the control [ ( 18.3 ± 6.98) μg/L,t =2.376,P ＜ 0.05 ].The serous G-CSF level of the GD patients with leucopenia was (40.1 ± 13.8 ) μg/L,significantly higher than that of the patients with normal leucocyte level ( t =2.788,P ＜ 0.01 ) and that of the control ( t =3.672,P＜0.01 ).180 d after the initiation of 131 I treatment,the G-CSF level of the patients with normal leucocyte level was (18.9 ± 8.32) μg/L,not significantly different from that of the normal controls,however,the G-CSF level of the GD patients with leucopenia was (25.7 ± 11.5) μg/L,still significantly higher than that of the normal control (t =2.103,P ＜ 0.05).The serous G-CSF level was negatively correlated with the titer of leucocyte ( r =- 0.38,P ＜ 0.05 ),however,not significantly correlated with such clinical parameters,as free triiodothyronine (FT3),free thyroxine (FT4) and thyrotropin-stimulating hormone (TSH).Conclusions Abnormal increment of G-CSF is observed in the GD patients,which may be related to the decrease of leucocyte.Effectively suppressing the auto-immune status in the GD patients,131I treatment is a safe and reliable therapy for GD patients with leucopenia and should be used as early as possible.