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甲状腺动脉栓塞治疗格雷夫斯病的长期免疫学研究。

Long-term immunological study in Graves' disease treated with thyroid arterial embolization.

作者信息

Zhao Wei, Gao Bu-Lang, Jin Cang-Zheng, Yi Gen-Fa, Yang Hui-Ying, Li Hong, Song Dian-Ping, Hu Ji-Hong, Jiang Yong-Neng

机构信息

Medical Imaging Center, First Affiliated Hospital, Kunming Medical College, 295 Xicang Road, Kunming, Yunnan Province, China.

出版信息

J Clin Immunol. 2008 Sep;28(5):456-63. doi: 10.1007/s10875-008-9209-0. Epub 2008 Jul 17.

Abstract

OBJECTIVE

The aim of this study was to investigate long-term immunological changes after the treatment of Graves' disease (GD) with thyroid arterial embolization and the effect of thyroid arterial embolization on the body's immunological functions.

MATERIALS AND METHODS

Forty-one patients with clinically and laboratorily ascertained GD were treated with thyroid arterial embolization and followed up for 3-54 months following embolization. Prior to embolization and at 1, 3, 6, 12, and 36 months following embolization, thyroid autoimmune antibodies were tested respectively, including thyroid stimulating antibody (TSAb), thyrotropin antibody (TRAb), thyroglobulin antibody (TGAb), and thyroid microsomal antibody (TMAb), as well as subgroup lymphocytes of CD16+CD56+, CD19+, CD3+, CD3+CD4+ and CD3+CD8+. The autoimmune status of GD patients prior to embolization and the dynamic changes of the immunological function after embolization were analyzed.

RESULTS

The therapy of thyroid arterial embolization could effectively decrease the activity/titer and positive rate of TRAb and the ratio of CD4+/ CD8+ to normal levels at 6 months following embolization, while the ratio of CD3+CD8+ increased gradually to normal level at 1 year following embolization. In patients with recurrence, TSAb and TRAb remained at a higher level, while the rate of CD3+CD8+ and the ratio of CD4+/CD8+ were not statistically significantly different from those before embolization.

CONCLUSION

Immunological functional disorder exists in GD patients. The treatment method of thyroid arterial embolization can effectively resume the basic immunological function to normal range while patients with recurrence have no significant improvement, suggesting that thyroid arterial embolization has an effective role in adjusting the immunological function.

摘要

目的

本研究旨在探讨甲状腺动脉栓塞治疗格雷夫斯病(GD)后的长期免疫学变化以及甲状腺动脉栓塞对机体免疫功能的影响。

材料与方法

41例临床及实验室确诊的GD患者接受甲状腺动脉栓塞治疗,并在栓塞后随访3至54个月。在栓塞前以及栓塞后1、3、6、12和36个月,分别检测甲状腺自身抗体,包括促甲状腺素抗体(TSAb)、促甲状腺激素抗体(TRAb)、甲状腺球蛋白抗体(TGAb)和甲状腺微粒体抗体(TMAb),以及CD16 + CD56 +、CD19 +、CD3 +、CD3 + CD4 +和CD3 + CD8 +亚群淋巴细胞。分析GD患者栓塞前的自身免疫状态以及栓塞后免疫功能的动态变化。

结果

甲状腺动脉栓塞治疗可有效降低TRAb的活性/滴度和阳性率以及CD4 + / CD8 +比值,使其在栓塞后6个月恢复至正常水平,而CD3 + CD8 +比值在栓塞后1年逐渐升高至正常水平。复发患者的TSAb和TRAb仍处于较高水平,而CD3 + CD8 +率和CD4 + / CD8 +比值与栓塞前相比无统计学差异。

结论

GD患者存在免疫功能紊乱。甲状腺动脉栓塞治疗方法可有效将基本免疫功能恢复至正常范围,而复发患者无明显改善,提示甲状腺动脉栓塞在调节免疫功能方面具有有效作用。

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