1型糖尿病合并自身免疫性甲状腺疾病患者临床特征和外周血相关血细胞因子表达水平的研究

目的：检测1型糖尿病合并自身免疫性甲状腺疾病（AITD）胰岛相关抗体及甲状腺相关抗体阳性率及其外周血Th1、Th2、Th17、Treg相关细胞因子表达水平，分析1型糖尿病合并AITD临床特点，探讨各细胞因子在1型糖尿病发生发展中的作用。方法收集1型糖尿病患者63例，对照组为来我院健康体检者57例，采集静脉血，检测胰岛相关抗体、甲状腺相关抗体及IFN-γ、IL-4、IL-10、IL-17细胞因子表达水平。结果1型糖尿病组 IFN-γ及 IL-17表达水明显高于正常对照组（400.95±51.44）pg/ml vs.（340.99±39.47）pg/ml，P＜0.01；（26.87±±2.47）pg/ml vs.（19.41±2.80）pg/ml，P＜0.01]，IL-4及IL-10表达水平均低于正常组（21.63±4.22）pg/ml vs.（31.49±2.42）pg/ml，P＜0.01；（15.69±3.22）pg/ml vs.（24.13±2.17）pg/ml，P＜0.01]，差异均有统计学意义。1型糖尿病任一胰岛相关抗体阳性组，TPO-Ab、TG-Ab、TR-Ab阳性率均高于胰岛相关抗体阴性组，差异有统计学意义（P＜0.05），但各细胞因子表达无明显差异。1型糖尿病患者血清IL-17水平与HbA1c水平正相关（r＝0.59，P＜0.05）。结论1型糖尿病患者CD4＋T细胞各亚群间平衡失调，Th1/Th2及Th17/Treg平衡失调，向Th1及Th17方向漂移，细胞免疫及IL-17介导的前炎症反应在1型糖尿病起病中发挥主要作用，1型糖尿病胰岛相关抗体阳性患者，具有更高的甲状腺相关抗体阳性率，可能具有更高的自身免疫性甲状腺疾病风险。

Related cytokines expression level in peripheral blood of patients with diabetes mellitus and autoimmune thyroid disease

Objective To detect the plasma concentrations of some cytokines expressed by relevant Th1, Th2, Th17, Treg and to observe the ratio of positive about glutamic acid decarboxylase antibodies（GAD-Ab）, insulin autoantibodies（IAA） and islet cell antibodies（ICA） who were diagnosed with type 1 diabetes（T1DM） and autoimmune thyroid disease（AITD）. Analysis the clinical characteristics and to explore the use of these cytokines in the development of these patients. Methods 63 patients diagnosed with type 1 diabetes mellitus and autoimmune thyroid disease were collected, control group of 57 cases. Collected the peripheral blood, to detect islet-related antibodies, thyroid-associated antibodies. Sandwich enzyme-linked immunosorbent assay for detection of IFN-γ, IL-4, IL-10, IL-17. Results In type 1 diabetes group, IFN-γand IL-17 expression levels were higher than the normal control group. IL-4 and IL-10 were lower than the normal control group. In the group any one islet-related antibodies positive, TPO-Ab, TG-Ab, TR-Ab positive rates were higher, the difference was statistically significant （P〈0.05）, but the level of cytokines were not statistically significant. T1DM group serum IL-17 levels and HbA1c were positively correlated （r=0.59, P〈0.05）. Conclusion Type 1 diabetes CD4＋T cell subsets imbalance, Th1/Th2 and Th17/Treg are imbalance, cellular immunity and IL-17 mediated inflammatory play major role in T1DM. In type 1 diabetes patients any one islet-related antibodies positive, have higher rates of thyroid-associated antibodies, may have a higher risk of autoimmune thyroid disease.