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目的:研究Graves病患者外周血中Th17细胞及IL-17、IL-23的表达水平并探讨其临床意义。方法:用流式细胞仪检测29例Graves病患者治疗前后(GD组,GD缓解组)和29名健康对照者(NC组)外周血PBMC中CD4~+IL-17~+T细胞比例,用ELISA法检测血清中IL-17和IL-23浓度,用电化学发光法检测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,用放射受体分析法测定抗促甲状腺激素受体抗体(TrAb)水平。结果:3组之间年龄、性别差异均无统计学意义(F=0.007 5,P>0.05;χ~2=0.4213,P>0.05)。GD组和GD缓解组Th17比例、IL-17、IL-23的水平显著高于NC组,差异有统计学意义(P均<0.05)。GD缓解组的Th17比例、IL-23浓度显著低于GD组,但GD缓解组IL-17浓度与GD组的差异无统计学意义(P>0.05)。Th17比例、IL-17、IL-23与FT3、FT4、TrAb均呈正相关(r值依次为:0.588 2、0.3372、0.371 0;0.549 6、0.287 5、0.342 7;0.361 0、0.420 8、0.330 8;P均<0.05)。Th17比例、IL-17、IL-23与TSH均呈负相关(r值依次为-0.319 7、-0.472 8、-0.428 2;P均<0.05)。结论:Th17细胞及其相关细胞因子IL-17、IL-23在GD患者外周血中均高表达;并与GD患者的甲功4项指标具有不同程度的相关性。Th17细胞及相关细胞因子IL-17、IL-23能够作为GD的生物学标记物。
Objective: To study the expression of Th17 cells, IL-17 and IL-23 in peripheral blood of patients with Graves’ disease and to explore its clinical significance. Methods: The proportion of CD4 ~ + IL-17 ~ + T cells in peripheral blood of 29 patients with Graves’ disease before and after treatment (GD group, GD remission group) and 29 healthy controls (NC group) were detected by flow cytometry Serum levels of IL-17 and IL-23 were detected by ELISA, serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were detected by electrochemiluminescence. The level of anti-thyroid hormone receptor antibody (TrAb) was measured by body analysis. Results: There was no significant difference in age and sex between the three groups (F = 0.007 5, P> 0.05; χ ~ 2 = 0.4213, P> 0.05). The levels of Th17, IL-17 and IL-23 in GD and GD remission group were significantly higher than those in NC group (all P <0.05). The Th17 ratio and IL-23 concentration in GD remission group were significantly lower than those in GD group, but there was no significant difference between GD remission group and GD group (P> 0.05). Th17 ratio, IL-17, IL-23 and FT3, FT4, TrAb were positively correlated (r values were: 0.588 2,0.3372,0.371 0; 0.549 6,0.287 5,0.342 7; 0.361 0,0.420 8,0.330 8 ; P <0.05). Th17 ratio, IL-17, IL-23 and TSH were negatively correlated (r values were -0.319 7, -0.472 8, -0.428 2; P all <0.05). Conclusion: Th17 cells and their related cytokines, IL-17 and IL-23, are highly expressed in peripheral blood of patients with GD, and have different degrees of correlation with four indicators of thyroid function in patients with GD. Th17 cells and related cytokines IL-17, IL-23 can serve as biological markers of GD.