摘要
目的探讨不同碘摄人量对桥本甲状腺炎（HT）患者体内细胞免疫、体液免疫指标的影响。方法对临床诊断为HT76例患者，依据尿碘中位数（MUI）491．20μg/L分为两组，≥MUI者为HTⅠ组，共37例，〈MUI者为HTⅡ组，共39例，选取甲状腺功能正常的健康人49例作为对照组，分别对其进行游离甲状腺素（FT4）、游离三碘甲腺原氨酸（FT3）、促甲状腺激素（TSH）、甲状腺球蛋白抗体（TGAb）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺激素受体抗体（TRAb）、肿瘤坏死因子α（TNF-α）测定。结果HTⅠ组FT3、FT4水平分别为（2．67±1．93）、（4．22±3．77）pmo]／L，HTⅡ组分别为（3．19±1．63）、（5．99±3．97）pmol／L，明显低于对照组的（5．30±1．10）、（16．50±2．70）pmol／L，差异有统计学意义（P〈0．01）；HTI组和HT1I组TNF-α水平分别为（6．14±1．83）、（6．09±1．50）ng/L，明显高于对照组的（1．90±0．60）ng／L，差异有统计学意义（P〈0．01）；HTⅠ组FT3、FT4水平低于HTⅡ组，TNF-α水平高于HTⅡ组，但差异无统计学意义（P〉0．05）；HTⅠ组和HTⅡ组TPOAb、TGAb阳性率[97．3％（36／37）、81．1％（30／37）和89．7％（35／39）、74．4％（29/39）]明显高于对照组[18．4％（9149）、12．2％（6／49）]，差异有统计学意义（P〈0．01）；HTⅠ组与HTⅡ组TPOAb、TGAb、TRAb阳性率比较差异无统计学意义（P〉0．05），但HTⅠ组TPOAb、TGAb高滴度患者所占比率高于HTⅡ组，差异有统计学意义（P〈0．05），HTⅠ组TRAb水平（1．25±0．14）mU／L，高于HTⅡ组的（1．16±0．21）mU／L，但差异无统计学意义（P〉0．05）。相关分析显示FT3与TGAb、TPOAb呈负相关（r=-0．342、-4）．397，P〈0．05），TNF-α与TGAb、TPOAb呈正相关r=0．405、0．561，P〈0．05）。结论高碘摄入影响HT患者的自身免疫机制，应艰制HT患者的摄碘量。
Objective To study the relationship between cellular immunity in vivo,huraorat immunity and different iodine intakes in patients with hashimoto thyroiditis（HT）. Methods Seventy-six HT patients were divided into two groups according to the median of urine iodine （MUI = 491.20 μ g/L）-HTⅠ group （urine iodine≥MUI） with 37 cases and HT Ⅱ group （urine iodine 〈 MUI） with 39 cases. And 49 healthy persons were selected as control groupl The level of free three triiodothyronine （FT3）, free thyroxine （FT4）,thyroid stimulating hormone （TSH）,thyroglobulin antibody （TGAb） ,thyroid peroxidase antibody（TPOAb）, thyroid hormone receptor antibody （TRAb）, tumor necrosis factor-alpha （TNF- α ）of all groups were detected. Results The levels of FT3 and FT4 in HT Ⅰ group [ （2.67 ± 1.93 ）, （4.22 ± 3.77） pmol/L ] and HT Ⅱ group [ （3.19 ± 1.63 ）, （ 5.99 ± 3.97 ） pmol/L ] were significantly lower than those in control group [（5.30 ± 1.10）, （16.50 ± 2.70） pmol/L]（P〈 0.01）. The levels of TNF-α in HT Ⅰgroup [（6.14 ± 1.83） ng/L] and HTⅡ group [ （6.09 ± 1.50） ng/L] were both obviously higher than that in control group [ （ 1.90 ± 0.60） ng/L] （P 〈 0.01 ）. The levels of FT3 and FT4 were lower and TNF-α was higher in HT Ⅰ group than those in HTⅡ group, but there was no statistically significance （P 〉 0.05）. The positive rate of TPOAb, TGAb in HT Ⅰ group [ 97.3% （36/37）, 81.1% （ 30/37 ） ] and HT Ⅱgroup [ 89.7% （35/39）, 74.4% （29/39） ] were significantly higher than those in control group [ 18.4% （9/49）, 12.2% （6/49） ] （P 〈 0.01 ）. There was no statistically difference of the positive rate of TPOAb,TGAb and TRAh between HT Ⅰ group and HT Ⅱ group （P 〉 0.05 ）. While the percentage of patients with high titer of TPOAb and TGAb in HT Ⅰgroup was higher than that in HTⅡ group,and there was statistical difference（P〈 0.05）. The level of TRAb in HT Ⅰ group was higher than that in HT Ⅱ group [ （ 1.25 ± 0.14） mU/L vs. （ 1.16 ± 0.21 ） mU/L] ,but there was no significant difference （P 〉 0.05 ）. Correlated anlysis showed that FT3 was negatively correlated with TGAb and TPOAb （r =-0.342,-0.397,P 〈0.05）,and TNF-αwas positively correlated with TGAb and TPOAb （r = 0.405,0.561 ,P 〈 0.05）. Conehtsions High iodine intake influences the autoimmune mechanism of HT patients. The iodine intake should be limited in HT patients.
出处
《中国医师进修杂志》
2012年第19期33-36,共4页
Chinese Journal of Postgraduates of Medicine
