甲状腺相关眼病患者血清中Th1 Th2型细胞因子平衡偏离的研究

目的 探讨血清中Th1、Th2型细胞因子平衡偏离与甲状腺相关眼病(thyroid-associated ophthalmopathy,TAO)发病、活动性及大剂量糖皮质激素治疗反应的关系.方法 选取TAO患者52例,按CAS评分标准将其分为活动期29例(CAS≥4)和非活动期23例(CAS＜4).其中活动期患者中有22例给予大剂量糖皮质激素治疗;另外选取初诊Graves病患者15例及正常对照15例,收集上述人静脉血,行激素冲击治疗的患者于冲击前后各抽血1次.采用放射免疫法检测血清中IL-4浓度,ELISA法检测IFN γ浓度.比较活动期与非活动期TAO组、GD组以及正常对照组血清上述指标的变化;评价糖皮质激素治疗对上述指标的影响.结果 ①TAO及GD患者血清中IL-4、IFNγ浓度均较对照组明显增高.②活动期TAO与非活动期TAO相比血清中IL-4、IFN7浓度无明显统计学差异,但活动期IL-4/IFN γ比值较非活动期降低,有统计学差异.③22例激素冲击治疗患者中15例有效(CAS减少≥2),7例无效(CAS减少＜2),有效组治疗后血清中IFN γ浓度明显较治疗前降低,IL-4/IFNγ比值增高,而无效组未见明显变化.结论 Th1/Th2在一定程度可以作为TAO活动性判断指标之一,活动期TAO Th2/Th1比值下降,非活动期无明显变化.在一定程度还可以作为大剂量糖皮质激素治疗疗效的判断指标之一,有效者Th2/Th1比值上升,向Th2偏移,无效者治疗前后无明显改变.

Study on the disturbed balance of serum Th1,Th2 cytokines in thyroid-associated ophthalmopathy

Objective To evaluate the relationship between the deviation of Th1,Th2 serum cytokines and the activity of TAO,and the influence of glucocorticoid on Th1,Th2 serum cytokines balance in patients with TAO.Methods Serum cytokines IL-4 and IFN γ were detected in four goups of subjects:29 patients with active TAO,23 patients with inactive TAO,15 patients with Graves'disease without ophthalmopathy(GD),15 healthy volunteer and 22 patients with active TAO after high-dose methylprednisolone therapy.The level of IL-4 was determined using simultaneous radio immunoassay,and the level of IFNγ was determined IFNγ was declined markedly,and the balance of serum cytokines IL-4/IFNγ increased.In non-responders,the balance of serum cytokines was no significant change.Conclusion A disturbed balance between serum Th1 and Th2 cytokines may decide the reactiveness of TAO in some degree.The efficient glucocorticoid therapy may be related to its influence on Th2/Th1 cytokines balance.IL-4/IFNγ is upregulated during successful treatment with glucocorticoid.But in glucocorticoid-resistant individuals,there are on significant differences in Th2:Th1 cytokines ratios studied.