| Part one:The study of effect and safety of glucorticosteroids therapy in patients with Graves'hyperthyroidismOb j ect i ve:observe the different routes of administration and different doses of the corticosteroids therapy in new and reccurent Graves' hyperthyroidism to investigate the effects and adverse reactions.Methods:101 patients of GD were divided into 3 groups named A, B, and C. Group A were treated with intravenous of methylprednisone 40mg once a day. Group B were treated with oral prednisone 30mg once a day. Group C were treated with oral prednisone 15mg once a day.Result:(1) 2 weeks of corticosteroids treatment, the thyroid functions of three groups was significantly improved(P<0.01); and there was no statistical difference among the three groups (P>0.05).2 weeks after treatment among the three groups to reduce the total efficiency FT3 and FT4 was no significant difference in efficiency (P > 0.05), while the excellent rate to reduce the serum FT3 levels in group A and B (58.69% and 64.29%) were significantly higher than group C(33.33%)after treatment(P<0.05); A and B group showed no significant difference (P> 0.05). (2) After 4 weeks, the titer of TRAb among the three groups were reduced. The excellent rate and total efficiency of reduced TRAb in group A and B compared with group C were significantly higher (P<0.05), while the group A and B showed no significant difference (P> 0.05). (3) After 2 weeks treatment, the symptoms and signs of the three groups were significantly improved; and A, B group goiter, proptosis, liver function improved the overall efficiency compared with C group were significantly different (P<0.05), while between the group A and B there were no significant difference (P> 0.05). And there was no significantly adverse reactions occurred.Conclusion:(1) we observed that the symptoms were alleviated and serum FT4, FT3 levels decreased after treatment compared with provious treatment. The glucocorticoids therapy can reduce thyroiditis and suppress the TRAb levels. These findings suggest that glucocorticosteroids is a effective and safe way to treat GD. (2) 2 weeks of glucocorticoid therapy can improve the signs and symptoms of hyperthyroidism in GD patients, for future anti-thyroid drug therapy laid the foundation for security. (3) Intravenous methylprednisolone 40mg/d and oral prednisolone 30mg/d for patients with severe Graves' hyperthyroidism were good. Oral prednisone 15mg/d for general patients.Part two:The expression and clinical value of peripheral blood CD4+CD25+ regulatory T cells in patients with Graves hyperthyroidismObserve:To observe the expression of peripheral blood CD4+and CD4+CD25+ regulatory T cells (Treg) in patients with Graves disease(GD), and to search the immune-mechanism of Graves disease.Methods:We examine the proportion of CD4+ and CD4+CD25+T cell from 25 GD patients and 12 normal controls by Flow Cytometry(FCM), and observe the correlations between CD4+CD25+Treg and clinical data, and explore the significance of Treg in pathogenesis of GD.Results:(1) There was no significant difference in the percentage of CD4+T cells between GD patients and normal control group(P>0.05), and the percentage of CD4+CD25+Treg in peripheral blood was no significant difference in GD patients (P>0.05)when compared with normal control groups. (2) The quantity of CD4+CD25+Treg was no correlation with thyroid function (P>0.05). The quantity of CD4+CD25+Treg was no correlation with TRAb, TGAb, TPO-Ab(P>0.05).Conclusion:Our results suggest that the proportion of Treg cells in GD patients are similar to those in normal groups. It indicate that the pathogenesis of GD hyperthyroidism is complicated, not entirely dependent on CD4+CD25+Treg abnormal cells. |
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