丙基硫氧嘧啶和甲巯咪唑治疗Graves病的免疫学作用

目的 观察丙基硫氧嘧啶(PTU)和甲巯咪唑(MMI)治疗Graves病(GD)患者促甲状腺素受体抗体(TRAb)、可溶性细胞间黏附分子1(sICAM-1)水平的变化。方法 106例临床确诊的GD患者分为PTU和MMI组，每组53例，两组在治疗量期、减量期、维持期均予规律用药，共36个月。TRAb和sICAM-1均以酶联免疫吸附法(ELISA)测定。结果 (1)两组治疗前一般情况比较差异无统计学意义(P＞0.05)。(2)PTU组与MMI组治疗前TRAb阳性率分别为94.33％、98.11％，两组间无显著差异；治疗36个月后临床缓解率两组间无显著差异（83.02％对88.68％），临床治愈率MMI组明显高于PTU组（58.49％对37.74％，P＜0.05）。(3)两组TRAb水平治疗前及治疗后6、12、24、30和36个月均有显著差异（均P＜0.01），随时间增加逐渐下降( F=275.48,P＜0.01)；两药物组治疗后TRAb水平存在显著差异(F=5.86,P＜0.05)。(4)两组sICAM-1水平在用药36个月后与用药前相比差异有统计学意义(P＜0.01)，而两药物组间sICAM-1无显著差异。结论 PTU和MMI均能够改善GD患者的自身免疫状态，而MMI的免疫抑制作用较为明显。

Immune effect of propylthiouracil and methimazole in the treatment of Graves' disease

Objective To observe the changes in TSH receptor antibody (TRAb) and soluble intercellular adhesion molecule-1 ( sICAM-1 ) levels after treatment of propylthiouracil ( PTU ) and methimazole( MMI ) in patients with Graves' disease (GD). Methods One hundred and six cases of clinically diagnosed patients with GD were divided into PTU and MMI groups( each group, n =53 ). The patients in two groups were regularly followed for 36 months. TRAb and sICAM-1 were measured with ELISA method. Results( 1 ) The general data of two groups were not significantly different before treatment( all P＞0. 05 ). ( 2 ) There was no difference in TRAb positive rates between two groups before treatment. The clinical remission rates between PTU and MMI groups showed no difference (83.02％ vs88.68％ ). The cure rate was higher in MMI group than in PTU group( 58.49％ vs 37.74％, P＜ 0. 05 ). (3) There existed significant differences in TRAb levels determined before and 6, 12, 24,30, and 36 months after treatment( all P＜0. 01 ), being gradually decreased with time( F=275.48 ,P＜0.01 ). TRAb levels between two groups were significantly different( F=5.86, P＜0. 05 ). (4) sICAM-1 levels at 36 months after treatment compared with the baseline in both groups were statistically different (P＜0. 01 ), but no difference was found between two groups. ConclusionsBoth PTU and MMI improve the immune status of patients with GD, and the immunosuppressive effect of methimazole is more evident.