CAJ | 학술논문

目的探讨131I治疗Graves病(GD)对患者外周血粒细胞集落刺激因子(G-CSF)和白细胞的影响.方法采用酶联免疫吸附试验( ELISA)、Coulter 3分类血细胞分析和放射免疫分析法( RIA),分别检测初发43例白细胞正常和22例白细胞减少的GD患者于131I治疗前及治疗后30、90和180 d血清G-CSF水平、白细胞总数和甲状腺激素水平,并进行相关性分析.30例年龄与性别相匹配的健康者作为健康对照.结果 GD患者中白细胞正常组血清G-CSF水平(28.4±11.7)μg/L显著高于健康对照组(18.3 ±6.98) μg/L(t=2.376,P＜0.05)；白细胞减少组血清G-CSF水平(40.1±13.8) μg/L升高(t=3.672,P＜0.01)；131I治疗180 d后,甲状腺功能恢复正常,症状缓解,血清G-CSF水平逐渐下降,但白细胞减少组(25.7±11.5) μg/L仍高于健康对照组(t=2.103,P＜0.05)；GD患者G-CSF与白细胞呈负相关(r=-0.38,P＜0.05),与FT3、FT,、TSH没有相关性.结论 GD患者体内存在G-CSF异常表达,可能与白细胞减少有关；131I治疗能有效抑制GD患者自身免疫,可能是治疗伴白细胞减少GD患者一种安全可靠、疗效显著的方法,宜尽早选用.
목적 탐토131I치료Graves병(GD)대환자외주혈립세포집락자격인자(G-CSF)화백세포적영향.방법 채용매련면역흡부시험( ELISA)、Coulter 3분류혈세포분석화방사면역분석법( RIA),분별검측초발43례백세포정상화22례백세포감소적GD환자우131I치료전급치료후30、90화180 d혈청G-CSF수평、백세포총수화갑상선격소수평,병진행상관성분석.30례년령여성별상필배적건강자작위건강대조.결과 GD환자중백세포정상조혈청G-CSF수평(28.4±11.7)μg/L현저고우건강대조조(18.3 ±6.98) μg/L(t=2.376,P＜0.05)；백세포감소조혈청G-CSF수평(40.1±13.8) μg/L승고(t=3.672,P＜0.01)；131I치료180 d후,갑상선공능회복정상,증상완해,혈청G-CSF수평축점하강,단백세포감소조(25.7±11.5) μg/L잉고우건강대조조(t=2.103,P＜0.05)；GD환자G-CSF여백세포정부상관(r=-0.38,P＜0.05),여FT3、FT,、TSH몰유상관성.결론 GD환자체내존재G-CSF이상표체,가능여백세포감소유관；131I치료능유효억제GD환자자신면역,가능시치료반백세포감소GD환자일충안전가고、료효현저적방법,의진조선용.
Objective To observe the effects of 131I treatment on circulating granulocyte colonystimulating factor (G-CSF) and leucocyte levels of patients with Graves' disease (GD).Methods Enzyme-linked immunosorbent assay (ELISA),coulter three assortments,and radioimmunoassay were used to test the levels of circulating G-CSF,leucocytes and thyroid hormones of 65 incipient and untreated GD patients,all females,aged 21 -50,43 with normal leucocyte level and 22 with leucopenia before and after 131I treatment.Thirty age-matched healthy female subjects were used as controls.Results Before 131I treatment,the serous G-CSF level of the GD patients with normal leucocyte level was (28.4 ± 11.7)μg/L,significantly higher than that of the control [ ( 18.3 ± 6.98) μg/L,t =2.376,P ＜ 0.05 ].The serous G-CSF level of the GD patients with leucopenia was (40.1 ± 13.8 ) μg/L,significantly higher than that of the patients with normal leucocyte level ( t =2.788,P ＜ 0.01 ) and that of the control ( t =3.672,P＜0.01 ).180 d after the initiation of 131 I treatment,the G-CSF level of the patients with normal leucocyte level was (18.9 ± 8.32) μg/L,not significantly different from that of the normal controls,however,the G-CSF level of the GD patients with leucopenia was (25.7 ± 11.5) μg/L,still significantly higher than that of the normal control (t =2.103,P ＜ 0.05).The serous G-CSF level was negatively correlated with the titer of leucocyte ( r =- 0.38,P ＜ 0.05 ),however,not significantly correlated with such clinical parameters,as free triiodothyronine (FT3),free thyroxine (FT4) and thyrotropin-stimulating hormone (TSH).Conclusions Abnormal increment of G-CSF is observed in the GD patients,which may be related to the decrease of leucocyte.Effectively suppressing the auto-immune status in the GD patients,131I treatment is a safe and reliable therapy for GD patients with leucopenia and should be used as early as possible.