【作者】 胡天一；

【导师】 刘戈力；

【作者基本信息】 天津医科大学 ， 儿科学， 2009， 硕士

【摘要】 目的:观察血清趋化因子CXCL10的水平在AITD患儿(包括GD和HT)不同病程的变化情况,研究血清CXCL10的水平与甲状腺功能(FT3、FT4、sTSH)和甲状腺自身抗体(TGAb、TMAb、TRAb、TSI)指标之间的关系,探讨趋化因子CXCL10在儿童AITD的发病机制和病程中的作用。方法:天津医科大学总医院儿科内分泌门诊AITD病例(其中包括57例GD病人和53例HT病人)及30例正常对照组儿童,收集他们的临床资料和血清。测定所有患儿和正常对照组的甲状腺功能和甲状腺自身抗体的水平,并采用ELSIA方法测定所有患儿和正常对照组的血清CXCL10的水平。比较三组(GD组、HT组和正常对照组)血清CXCL10的水平。把GD和HT病人分为新发病组、未缓解组及缓解组,比较各组及每组与正常对照组之间血清CXCL10的水平;比较24例GD患儿经甲巯咪唑治疗前后血清CXCL10的水平。相关分析AITD患儿血清CXCL10水平与甲状腺功能及甲状腺自身抗体水平的关系。结果:1儿童GD病人中血清CXCL10的水平高于正常对照组(P＜0.01)。儿童HT病人中血清CXCL10的水平高于正常对照组(p＜0.05)。GD组的血清CXCL10的水平高于HT组(p＜0.05)。2 GD组儿童GD新发病组、未缓解组的血清CXCL10的水平高于缓解组(p＜0.001)和正常对照组(p＜0.001);新发病组与未缓解组的血清CXCL10的水平比较差别无统计学意义(p＞0.05);缓解组和正常对照组血清CXCL10的水平比较差别无统计学意义(p＞0.05);24例GD患儿,经甲巯咪唑治疗后血清CXCL10水平较治疗前下降,差别有统计学意义(p＜0.001)。GD组血清CXCL10水平与甲功指标FT3、FT4呈正相关(p＜0.05),与sTSH无相关性,与甲状腺自身抗体指标TGAb、TMAb、TRAb无相关性;与TSI呈正相关(p＜0.05)。3 HT组儿童HT新发病组血清CXCL10的水平比缓解期和正常对照组升高(p＜0.001),未缓解期血清CXCL10的水平比缓解期和正常对照组升高(p＜0.05)新发病组与未缓解组的血清CXCL10的水平比较差别无统计学意义(p＞0.05);缓解组和正常对照组血清CXCL10的水平比较差别无统计学意义(p＞0.05)。HT组血清CXCL10的水平与sTSH呈正相关,与甲功指标FT3、FT4无相关,与甲状腺自身抗体指标TGAb、TMAb、TRAb、TSI无相关性。结论:1自身免疫性甲状腺疾病患儿CXCL10均高于正常对照组,说明趋化因子CXCL10参与儿童AITD发生发展的免疫调控。2趋化因子CXCL10在儿童AITD的发病早期和复发期升高,在儿童AITD缓解后降低。说明趋化因子CXCL10在儿童AITD的发病早期起重要作用,并与疾病的严重程度密切相关,可以作为预测儿童AITD的疾病活动性的指标之一。更多还原

【Abstract】 Objective:To observe the change of serum chemokine CXCL10 in children with AITD including Graves’ Disease.(GD) and Hashimotos thyroiditis(HT) when they were in different course of disease.To study the relationship between the level of serum chemokine CXCL10 and the level of function of thyroid(FT3、FT4、sTSH) and the relationship between the level of serum chemokine CXCL10 and the level of thyroid antibody(TGAb、TMAb、TRAb、TSI),and then explore the role of chemokine CXCL10 in children with AITD when they were inatial stage and different course.Methods:The children AITD cases of Tianjin medical university hospital pediatric endocrine clinic and their serum were random collected from January 2008 to January 2009,which included 53 cases with HT and 57 cases with GD and 30 controls.To determinate the level of function of thyroid and the level of thyroid antibody.To determinate their serum level of CXCL10 by ELISA method.To compare their serum levels of CXCL10 among three groups.To compare the serum level of CXCL10 in HT and GD when they were patients onset、non-remission and remission and controls;To compare the serum level of CXCL10 in 24 patients with GD when they were before therapied by MMI and therapied after 3-6 months.Make relationship analysis between the level of CXCL10 and the level of FT3、FT4、sTSH、TGAb、TMAb、TRAb、TSI in GD and HT.Results:1(1) The level of serum CXCL10 in 57 patients with GD was significant higher than controls(p＜0.001).(2) The level of serum CXCL10 in 53 patients with HT was significant higher than controls(p＜0.05).(3) The level of serum CXCL10 in GD was significant higher than HT(p＜0.05).2 GD group The level of serum CXCL10 in GD when they were patients onset、non-remission was significant higher than they were remission(p＜0.001) and controls(p＜0.001).There was no difference between patients onset and non-remission(p＞0.05).There was no difference between patients remission and controls(p＞0.05).The level of serum CXCL10 in 24 patients with GD before they therapied was significant higher than they were therapied by MMI after 3-6 months (p＜0.001).In GD group there was positive correlation between CXCL10 and FT3、FT4;there was no correlation between CXCL10 and TSH;there was no correlation in GD group between CXCL10 and TGAb、TMAb、TRAb,there was positive correlation between CXCL10 and TSI(p＜0.05).3 HT group The level of serum CXCL10 in HT when they were patients onset was significant higher than they were remission and controls(p＜0.001).The level of serum CXCL10 in HT when they were patients non-remission was significant higher than they were remission and controls(p＜0.05).There was no difference between patients onset and non-remission(p＞0.05).There was no difference between patients remission and controls(p＞0.05).In HT group there was positive correlation between CXCL10 and sTSH(p＜0.01),there was no correlation between CXCL10 and FT3、FT4(p＞0.05);there was no correlation between CXCL10 and TGAb、TMAb、TRAb、TSI(p＞0.05).Conclusion:1 The level of serum chemokines CXCL10 in children AITD was higher than controls, so this study supporting that chemokines CXCL10 may participate in the immunoregulation of children AITD when they were invasion and development.2 The circulating concentrations of CXCL10 have been found to be increased in GD and HT when they were initial stage and relapses,and they have been found to be decreased in AITD when they were remission.CXCL10 play an important role in the initial stage of children with AITD.,and there was close correlation between CXCL10 and the severity degree of disease.So CXCL10 may be as one of index to predict the reactiveness of disease.更多还原