Association between intravenous pulse-therapy with immunosuppressant for Graves' ophthalmopathy and changes of peripheral blood T cell subgroup / 第二军医大学学报

ABSTRACT

Objective: To study the association between the outcomes of intravenous pulse-therapy with immunosuppressants and the changes of peripheral blood T cell subgroup in patients with Graves' ophthalmopathy (GO). Methods: Fifty-eight patients with GO were randomized into 2 groups (n=29). All patients received antithyroid drugs orally and (or) Levothyroxine; they also received intravenous meprednisone (0.5 g) and cyclophosphamide (0.2 g) once a day for 3 days. After an interval of 4 days the administration of meprednisone and cyclophosphamide was repeated. All patients received a total of 3-6 times of treatment. Patients in group A were given prednisone and cyclophosphamide orally after immunosuppressants. Patients in group B were injected with Dexamethasone into thyroid after immunosuppressants. Results: Two patients withdrew from group A and one from group B. The therapeutic effect in group B was significantly better than that in group A (P<0.05). Compared with before treatment, the degrees of exophthalmos and exophthalmos activity were significantly lowered after treatment (P<0.05); the thyrotropin receptor antibodies (TRAb), thyroid peroxidase (TPOAb), peripheral blood NK cells, CD3+ T lymphocytes, and CD8+ T lymphocytes were significantly reduced after treatment (P<0.05); the ratio of CD4+/CD8+ was increased after the treatment (P<0.05). The degrees of exophthalmos, exophthalmos activity and levels of CD3+ T lymphocytes decreased more significantly in group B than in group A (P<0.05). The ratio of CD4+/CD8+ increased more significantly in group B than in group A(P<0.05). Before treatment the counts of CD4+ T lymphocytes were markedly different between the effective, moderately effective, and the ineffective group (P<0.05). Significant differences in TRAb, TPOAb, CD3+, CD8+ cells were found among the 3 groups after treatment. (P<0.05). CD4+ T lymphocytes and CD4+/CD8+ ratio were significantly higher after treatment compared with those before treatment (P<0.05). Significant differences in TRAb, CD4+, CD8+ T lymphocytes, CD4+/CD8+ ratio were found among 3 groups (P<0.05). Conclusion: Combination of meprednison and cyclophosphamide can relieve the abnormality of peripheral blood T cells in GO and has obvious therapeutic effect. Additional intrathyroid injection of dexamethasone may achieve even better outcome. The reduction of CD4+ T lymphocytes in peripheral blood of GO patients may indicate poor prognsis.