Graves病131I治疗后一年内缓解和早发甲减患者血清IL-18和TRAb的变化分析

探讨131I治疗后一年内GD患者甲减的免疫功能状态的改变.采用CLIA、IRMA和EIA方法,监测41例GD患者131I治疗前后血清白细胞介素-18(IL-18)、促甲状腺素受体抗体(TRAb)、TPOAb的含量和甲状腺重量(TDW)变化.41例GD患者分为甲减组13例和缓解组28例.结果表明治疗前两组GD患者血清IL-18和TRAb水平明显升高,与对照组比较均有显著性差异(P＜0.01,P(0.05),两组间比较,血清FT3、FT4、sTSH、TDW和131I剂量均无显著性差异(P＞0.05).治疗后两组血清IL-18明显下降,甲减组血清sTSH升高明显(P＜0.01),而缓解组TDW明显减少(P＜0.05).两组患者治疗后的TRAb水平仍然较高(P＜0.05).IL-18与FT3、FT4和TDW呈正相关(r=0.372,P＜0.01;r=0.312,P(0.01;r=0.371,P＜0.01),与sTSH呈负相关(r=-0.224,P＜0.01).甲减组TPOAb升高的病例治疗前为4/13,治疗后为6/13;缓解组治疗前为10/28,治疗后为12/28.131I治疗后6～12个月内辐射对患者免疫系统的调控产生的直接影响较小,血IL-18含量变化如结合TRAb、TPOAb指标了解甲状腺Th1/Th2型免疫应答状态,对疗效观察和预后判断有阶段性指导作用.

Changes of the Serum IL-18 and TRAb in Patients with Graves' Disease after 131I Treatment Within One Year

To investigate immunological function change in Graves' disease(GD) patients with hypothyroidism within one year after 131I treatment,and evaluate the relationship between the 131I theatment and autoimmune thyroid disease.Serum levels of IL-18,TRAb and TPOAb in 41 patients with GD were determined by EIA,IRMA and CLIA,thyroid weight(TDW) were measured by B ultrasonic instrument.The patients were divided into two groups based on whether appear the early hypothyroidism after 131I treatment during 6~12 months graded as: the hypothyroidism group in 13 and the recovery group in 28;25 healthy people as control group.Results showed that the serum levels of IL-18 and TRAb in hypothyroidism group and recovery group were significantly increased before 131I treatment compared with control group(P<0.05).Between hypothyroidism and recovery groups,the levels of serum FT3,FT4,sTSH,TDW and 131I dosage were not significant differences(P>0.05).The serum levels of IL-18 in two groups were decreased(P<0.05),the serum sTSH levels in hypothyroidism group were elevated(P<0.01),TDW in recovery group were reduced(P<0.05),and the TRAb levels in two groups were still high after 131I treatment(P<0.05).Positive correlations between IL-18 and FT3,FT4,TDW(r=0.372 P<0.01,r=0.312 P<0.01,r=0.371 P<0.01),and negative correlations between IL-18 and sTSH were noted in GD(r=-0.224 P<0.01).Ratio of patients with serum TPOAb levels elevated in the hypothyroidism group were 4/13 before 131I therapy and 6/13 after therapy,and in the recovery group were 10/28 before therapy and 12/28 after therapy.These data suggest that radiation has a little influence on GD patients for adjusting immune system during 6~12 months after 131I treatment.The changes of serum IL-18 and combine with serum TRAb and TPOAb might be valuable implication for assessing the effect and prognosis of 131I treatment in patients with GD hyperthyroidism.