【作者】 沈浩；

【导师】 胡玲；

【作者基本信息】 南昌大学 ， 内科学， 2008， 硕士

【摘要】 目的:自身免疫性甲状腺疾病(autoimmune thyroid disease AITD)中Graves病(Graves’ disease GD)和桥本氏甲状腺炎(Hashimoto’s thyroiditis HT)是最常见的类型。依据产生的细胞因子(cytokine CK)的不同,辅助性T细胞(Th)主要分为Thl和Th2两类。Thl细胞分泌的细胞因子主要包括有白介素-2 (IL-2)、肿瘤坏死因子-α(tumor necrosis factor TNF-α);Th2细胞分泌的细胞因子主要包括白介素-4 (IL-4)、白介素-5(IL-5)。本文选择了临床确诊的GD与HT患者,利用观察性研究的方法,分析自身免疫性甲状腺疾病患者血清中Thl及Th2型细胞因子水平,探讨Thl/Th2细胞免疫平衡偏移以及Thl/Th2细胞免疫平衡在自身免疫性甲状腺疾病发生中的作用,同时观察细胞因子能否成为自身免疫性甲状腺疾病诊断的指标。方法:选取2007年8月至2008年3月在我院就诊的未经治疗的初诊AITD患者,其中GD患者45例、HT患者30例。另选20例体检合格的健康人作为正常对照组。所有入选的研究对象均抽取清晨空腹静脉血,两小时内利用放射免疫法测定游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、抗甲状腺球蛋白抗体(TGAb)、抗甲状腺微粒体抗体(TMAb),采用免疫放射法测定超敏促甲状腺激素(sTSH),剩余血清放置于-200C冰箱保存,5个月内所有剩余血清采用酶联免疫吸附试验法(ELISA)检测患者和健康人(对照组)血清中Thl型细胞因子白介素2 (IL-2)和Th2型细胞因子白介素5(IL-5)的水平并进行统计学分析。结果:1 GD组以及HT组中的TGAb和TMAb均较对照组明显增高,均为P<0.01。HT组TGAb与TMAb浓度较GD组高,P<0.05。2细胞因子在GD中的表达在GD患者中,IL-2与正常对照组相比无显著差异(P>0.05),而IL-5水平与其余两组相比有显著差异性(P<0.05)。3细胞因子在HT中的表达HT组患者血清IL-2水平明显高于GD组和对照组(P<0.05),而IL-5水平与其余两组相比无显著差异性(P>0.05)。4各组中的IL-2/IL-5比值情况GD组患者血清IL-2/IL-5比值降低,而HT组患者血清IL-2/IL-5比值增高,且二者相比有统计学差异,p<0.05。结论:1 TGAb与TMAb对于GD以及HT的诊断有重要价值,其中对于HT的诊断价值更为重要。2 Th2型细胞因子参与了GD的致病过程,GD是以Th2细胞免疫占优势为主的。3 Th1型细胞因子参与了HT的致病过程,HT是以Th1细胞免疫占优势为主的。更多还原

【Abstract】 OBJECT: The present classification of autoimmune thyroid disease (AITD) includes principally chronic autoimmune thyroiditis or Hashimoto’s thyroiditis (HT) and Graves’disease (GD). CD4+T helper precursor cells differentiate into two distinct subpopulations, Th1 andTh2. Th1 cells mainly secrete interleukine-2 (IL-2), IFN-γ, and TNF-α; Th2 cells mainly secrete interleukine-4(IL-4) and interleukine-5 (IL-5). Choosing GD and HT patients as research object, we analysis the serum concentrations of the Th1/Th2 cytokines interleukine-2 and interleukine-5 in patients AITD with and investigate the relationship between the imbalance of Th1/Th2 cytokines and the pathogenesis of AITD.METHODS: Chose 20 normal as controls, 75 patients were studied. 45 patients suffered from GD, 30 patients suffered from HT from Aug. 2007 to Feb. 2008 in the third affiliated hospital of Nanchang university. The serum concentrations of free triiodothyronine (FT3), free thyroxin (FT4) ,thyrotropic-stimulating hormone (TSH), thyroglobulin antibody(TGAb) and thyroid microsome antibody (TMAb)were assayed by radioimmunoassay (RIA) and the serum concentrations of thyrotropic-stimulating hormone (TSH) were assayed by immunoradioassay . The serum concentrations of IL-2 and IL-5,representative cytokines of Th1 and Th2 cells respectively,were assayed by enzyme-linked immunosorbent assay (ELISA). All data were analysis by statistics methods.RESULTS: (1) Compare with controls, the serum concentrations of TGAb and TMAb in GD and HT groups were remarkably increased (P<0.01); Compare with GD group, the concentration of TGAb and TMAb in HT group were remarkably increased (P<0.05). (2) Compare with HT group and controls, the concentration of IL-5 in GD group were remarkably increased (P<0.05). (3) Compare with GD group, the concentration of IL-2 in HT group were remarkably increased (P<0.05). (4) Compare with GD group, the ratio of IL-2/IL-5 in HT group were remarkably increased (P<0.05).CONCLUSIONS: (1) TGAb and TMAb play a very important role in the diagnosis of GD and HT, especially in the HT. (2) A Th1 pattern of immune response of characteristic cellular immunity is dominant in HT, whereas the predominance Th2 cytokines in GD indicates a humoral pattern of immune reaction.更多还原