糖皮质激素冲击疗法对 Graves 病患儿甲状腺功能及甲状腺自身抗体的影响。

Effects of glucocorticoid pulse therapy on thyroid function and thyroid antibodies in children with graves' disease.

机构信息

Department of Pediatrics, Linyi People's Hospital, NO.27, Eastern Jiefang Road, Linyi, 276000, Shandong Province, China.

Department of Nephrology, Linyi People's Hospital, NO.27, Eastern Jiefang Road, Linyi, 276000, Shandong Province, China.

出版信息

Ital J Pediatr. 2021 Mar 2;47(1):46. doi: 10.1186/s13052-021-00999-5.

DOI:10.1186/s13052-021-00999-5

PMID:33653401

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7923549/

Abstract

BACKGROUND

Glucocorticoid treatment is used in children with Graves' disease (GD) only in cases of exophthalmos. The purpose of this study was to observe the effects of glucocorticoid pulse therapy on thyroid function and thyroid antibodies in children with GD.

METHODS

Twenty children who were treated by intravenous methylprednisolone pulse therapy (MPT) followed by oral prednisolone administration and antithyroid drugs were included in the pulse group. Twenty children who were treated with antithyroid drugs alone were included in the control group. Serum concentrations of free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TGAb), and thyrotropin receptor antibodies (TRAb) were recorded at baseline and 10 days, 30 days, and 60 days after treatment.

RESULTS

Significant differences in FT3, FT4, TSH, TPOAb, TGAb, and TRAb levels were found in the pulse group and the control group from baseline to follow-up time points (all p < 0.05). On the 30th day, the TRAb level in the pulse group was significantly lower than that in the control group (p = 0.023). However, the level of TRAb rose on the 60th day. For values of TRAb at baseline, 10 days, and 60 days after treatment, there were no significant differences respectively between the pulse group and the control group (all p > 0.05). No significant differences were observed in FT3, FT4, TSH, TPOAb, and TGAb levels between the pulse group and the control group (all p > 0.05).

CONCLUSIONS

The results suggested that the effect of intravenous MPT followed by oral prednisolone on TRAb level was temporary in children with GD. Glucocorticoid pulse therapy was not beneficial for the sustained recovery of thyroid function.

摘要

背景

糖皮质激素治疗仅用于伴有突眼的格雷夫斯病（GD）患儿。本研究旨在观察糖皮质激素脉冲治疗对 GD 患儿甲状腺功能和甲状腺自身抗体的影响。

方法

将 20 例接受静脉注射甲泼尼龙脉冲治疗（MPT）后序贯口服泼尼松和抗甲状腺药物治疗的患儿纳入脉冲组，将 20 例单纯接受抗甲状腺药物治疗的患儿纳入对照组。记录两组患儿治疗前及治疗后 10 d、30 d、60 d 游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）和促甲状腺素受体抗体（TRAb）水平。

结果

脉冲组和对照组患儿 FT3、FT4、TSH、TPOAb、TGAb 和 TRAb 水平自基线至随访时间点均有显著差异（均 P<0.05）。第 30 天，脉冲组 TRAb 水平显著低于对照组（P=0.023），但第 60 天 TRAb 水平升高。治疗后第 10 天、第 60 天，两组患儿 TRAb 水平与基线相比差异均无统计学意义（均 P>0.05）。两组患儿 FT3、FT4、TSH、TPOAb 和 TGAb 水平在治疗后第 10 天、第 60 天与基线相比差异均无统计学意义（均 P>0.05）。