医学毕业论文甲状腺内注射免疫抑制剂治疗graves病的疗效观察及机制探讨.doc

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1、XX大学毕业论文甲犹腺内注射免疫抑制剂治疗⑥迩"的疗效观察及机制探姓名：2014年6月25日甲状腺内注射免疫抑制剂治疗Graves病的疗效观察及机制探讨作者：张慧钱春平左文标高明春【摘要】n的观察甲状腺内注射免疫抑制剂对Graves病的疗效及对周围血屮促甲状腺索受体抗体（TRAb）水平的影响，并探讨其机制。方法诊断明确的Graves病初发患者56例，随机分组，各组均口服甲號咪卩坐及普蔡洛尔，A组并予地塞米松注射液2.5mg+环磷酰胺50mg甲状腺内注射，毎周1次，共10次；B组予地塞米松注射液2.5mg甲状腺内注射；C组给予注射用水1ml甲状腺内注射，每周1次，共10次；比较治疗

2、前后及各组间临床症状、体征及血清游离甲状腺索（FT4）、游离三碘甲腺原氨酸（FT3）及TRAb变化。结果各组均能有效控制甲亢、降低FT3、FT4,但A、B组症状改善吋间均小于C组（P0.05）,甲状腺缩小程度均大于C组（P0.05）,A、B组间比较无显著性差界（P0.05）；A、B组TRAb转阴率明显高于C组（P0.01）,A组与B组比较12周时有显著性差异（P0.05）。结论甲状腺内注射免疫抑制剂治疗Graves病可较快改善症状，缩小甲状腺肿，缩短疗程，安全有效；其机制与其阻断甲状腺自身抗体、纠正机体免疫紊乱作用有关。【关键词】甲状腺；促甲状腺素受体抗体；Graves病Abst

3、ract:ObjectiveToobservetheeffectofintrathyroidinjectionofimmunosuppressorinpatientswithGraves'diseaseandstudyitsmechanism.MethodsFifty-sitpatientswithGraves'diseasewererandomlydividedintothreegroups.Theywerealltreatedwithoralmcthimazolandpropanololplusintrathyroidinjectionofdrugs.Injectionof2

4、.5mgdexamethasoneand50mgcyclophosphamidewasgiventogroupAonceaweekfortentimes,injectionof2.5mgdexamethasonealonetoGroupB,andinjectiononlyofsterilewatertoGroupC.Clinicalsymptomsandsigns,serumFT3,FT4andthyrotropinreceptor（TRAb）wereobservedbeforeandafterthetrcatmcnt.RcsultsThesymptomscouldbeeffec

5、tivelycontrolledinallofthe3groupsalongwiththedecreaseofscrumFT3andFT4,butthesymptomaticimprovementwaslesslastingingroupsAandBthaningroupC(P0.05)•TheshrinkageofthyroidwasmoremarkedingroupsAandB(P0.05)thoughnosignificantdifferencesweretherebetweengroupAandgroupB(P0.05).Thenegativeconversionrate

6、ofscrumTRAbwassignificantlyhigheringroupsAandBthaningroupC(P0.01),withcertaindifferencessignificantbetweengroupAandgroupBat12week(PO.05).ConclusionIntrathyroidinjectionofimmunosuppressorisapromisingtherapyforGraves'disease・Itscombinedusewithoralantithyroiddrugsmayenhancethereliefofsymptomsand

7、shrinkageofgoiter.ThemechanismhereisprobablyassociatedwithaninhibitoryeffectontheproductionofTRAbbythyroidlymphocytesandasimultaneouscorrectionofthealteredimmunorcactions.Keywords:thyroid;thyrotropinreceptor;Graves'diseaseGraves病(GD)的发生与自身免疫有