糖皮质激素改善活动期甲状腺相关眼病患者IL-17和IL-21的意义及其与效果的相关性

目的:探讨IL-17、IL-21在糖皮质激素治疗活动期甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)中的临床意义及与其治疗效果的相关性分析.方法:将我院收治的TAO患者67例134眼,按临床活动度评分标准(clinical activity score, CAS)分为活动期组和非典型活动期组,同时以30例60眼健康者为对照组,对活动期组患者采用糖皮质激素冲击疗法进行治疗,并于治疗前后进行CAS评分,测量突眼度和眼裂宽度,同时比较各组患者IL-17、IL-21的表达水平,并分析IL-17、IL-21与CAS评分的相关性. 结果:与对照组相比,TAO患者IL-17和IL-21表达均显著升高,差异有统计学意义(P<0.05);活动期TAO患者IL-17和IL-21的表达水平均高于非典型活动期,差异有统计学意义(P<0.05);糖皮质激素治疗后,活动期TAO患者IL-17和IL-21表达水平较治疗前均降低,差异有统计学意义(P<0.05),且活动期TAO患者IL-17的表达与CAS评分呈显著正相关(治疗前:r =0.8847,P=0.0462,治疗后:r=0.8886,P=0.0439),活动期TAO患者IL-21的表达与CAS评分呈显著正相关(治疗前:r=0.8893,P=0.0435;治疗后:r=0.8876,P=0.045). 结论:IL-17和IL-21与TAO病情活动密切相关,而糖皮质激素冲击治疗可通过降低活动期TAO患者IL-17和IL-21表达发挥作用,IL-17和IL-21可作为反映TAO患者病情和预测疗效的指标之一.

Changes of IL-17 and IL-21 in glucocorticoid therapy of active TAO and its relation with the results

AIM: To discuss the changes of IL-17, IL-21 in glucocorticoid therapy of active thyroid associated ophthalmopathy(TAO)and analyze the relation with results.

METHODS: The 67 patients(134 eyes)of TAO in our hospital, were divided into activity group(32 patients 64 eyes)and atypical activity group(35 patients 70 eyes)according clinical activity score(CAS)grading standard, and 30 cases of healthy as control group at the same time. The activity group were treated by glucocorticoid therapy treatment, and proceed the CAS scores before and after treatment, measured the degree of exophthalmus and width of palpebral fissure. At the same time, compared the expression level of IL-17 and IL-21 in all groups, and analyzed the correlation between the IL-17 and IL-21 and CAS score.

RESULTS: Compared with control group, expressions of IL-17 and IL-21 in TAO patients were significantly higher(P<0.05). The expressions of IL-17 and IL-21 in active period TAO patients were higher than atypical activity(P<0.05). After glucocorticoid treatment, the expressions of IL-17 in active period TAO patients decreased significantly(P<0.05), and it was significantly positive correlation with CAS score(before treatment: r=0.8847,P=0.042; after treatment: r=0.8886,P=0.0439)the expression of IL-21 in active period TAO patients was significantly positive correlation with CAS score(before treatment: r=0.8893, P=0.0435; after treatment: r=0.8876,P=0.045).

CONCLUSION: IL-17 and IL-21 is closely related to the TAO disease activity, and glucocorticoids impact treatment by reducing IL-17 and IL-21 in activity TAO, IL-17 and IL-21 can be used as one of indexes of predicted curative effect and condition in patients with TAO.