脱氧核苷酸钠片治疗新发Graves病的免疫学观察

曹含弘1*凌雁2陆志强2**

（1. 复旦大学附属中山医院青浦分院内分泌科 上海 201700；2. 复旦大学附属中山医院内分泌科 上海 200032）

摘 要目的：观察脱氧核苷酸钠治疗Graves病患者的免疫调节作用。方法：对203例新发的以甲巯咪唑治疗的Graves病患者随机分入脱氧核苷酸钠治疗组（A组）和利可君治疗组（B组）治疗1年，观察治疗后甲状腺激素恢复至正常范围的时间、TRAb滴度和达到正常的比例，以及细胞因子IL-1b、TNF-a、IL-6的改变。结果：A组甲状腺激素恢复到正常的时间较B组更快；治疗1年时，TRAb滴度两组间无显著差异，但A组TRAb恢复正常的百分率高于B组；治疗后两组间IL-1b无显著差异，而A组TNF-a、IL-6的下降较B组显著。结论：脱氧核苷酸钠治疗对Graves病患者有免疫调节作用。

关键词Graves病 脱氧核苷酸钠 免疫调节

Observation on the immunologic changes of patients with Graves’ disease treated with sodium deoxyribonucleotide

CAO Hanhong1*, LING Yan2, LU Zhiqiang2**

(1. Department of Endocrinology, Qingpu Branch, Zhongshan Hospital, Fudan University, Shanghai 201700, China;

2. Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China)

ABSTRACTObjective: To observe the immunologic changes of patients with Graves’ disease treated with sodium deoxyribonucleotide. Methods: Two hundred and three cases of new onset Graves’ disease patients treated with methimazole were randomly divided into group A (treated with sodium deoxyribonucleotide) and group B (treated with leucogen). Both groups were treated for 1 year and the time for the recovery of thyroid hormone to the normal range, the titer of TRAb and the ratio of TRAb returning to the normal, and the changes of the cytokines such as IL-1b, TNF-a, IL-6 were observed after treatment. Results: The time for the recovery of thyroid hormone to the normal value was shorter in group A than in group B. After 1 year treatment, the titer of TRAb between two groups had no significant difference, but the ratio of TRAb restoring to normal was higher in group A than in group B. After treatment, there was no significant difference in IL-1b between two groups, but TNF-a, IL-6 decreased more significantly in group A. Conclusion: Sodium deoxyribonucleotide treatment possesses an immunomodulatory effect on the patients with Graves’ disease.

KEY WORDSGraves’ disease; sodium deoxyribonucleotide; immune regulation

在Graves病（毒性弥漫性甲状腺肿）的治疗过程中，常联合应用脱氧核苷酸钠片以预防Graves病治疗过程中抗甲状腺药物所致的白细胞减少。据文献报道，脱氧核苷酸钠有缩短甲状腺功能恢复时间、防止白细胞减少及粒细胞缺乏的作用。那么，脱氧核苷酸钠增强免疫的作用是否存在加重自身免疫性甲状腺疾病的可能？基于此，我们设计了对甲巯咪唑联合脱氧核苷酸片治疗的Graves病患者免疫指标的研究。

1 临床资料

1.1 研究对象

以门诊初发的Graves病患者为研究对象，患者均符合2007年中华医学会内分泌学分会《中国甲状腺疾病诊治指南》，患者白细胞总数＞3.5×109/L，中性粒细胞绝

对数1.8×109/L，肝功能检查谷丙转氨酶及谷草转氨酶小于正常值上限2.5倍，肾功能正常，心功能（NYHA）分级不高于2级。……