本文選題：甲狀腺相關(guān)眼病 + 淚液細胞因子�。� 參考：《南方醫(yī)科大學(xué)》2012年碩士論文

【摘要】：研究背景 甲狀腺相關(guān)眼病(Thyroid associated ophthalmopathy, TAO)是一種與甲狀腺自身免疫疾病密切相關(guān)的眼部疾病,常伴隨著Graves'病(Graves'disease,GD)發(fā)生,臨床上又稱為Graves眼病(Graves ophthalmopathy, GO),其眼部表現(xiàn)具有顯著的特征：輕者僅有眼部不適、眼瞼退縮；重者出現(xiàn)突眼、復(fù)視,甚至視力喪失。目前還沒有令人滿意的治療方法。 TAO發(fā)病機制尚不完全明了,較公認的為“共同抗原學(xué)說”,即眼外肌膜成纖維細胞與甲狀腺交叉抗原表達,導(dǎo)致眶內(nèi)活性淋巴細胞浸潤,釋放各種細胞因子,作用于眼眶組織,引起眼眶的炎癥反應(yīng),同時刺激成纖維細胞分泌糖胺聚糖(Glycosaminoglycans, GAG),大量親水性GAG堆積繼而導(dǎo)致眼球突出等一系列臨床癥狀,其中TSHR可能作為主要交叉抗原在TAO發(fā)病機制中起重要作用。球后成纖維細胞、淋巴細胞及其分泌的細胞因子在TAO的發(fā)生、發(fā)展中發(fā)揮了關(guān)鍵作用,也成為目前較為公認的發(fā)病機制所在。之前的研究證實不同分期TAO外周血和球后組織中細胞因子的表達具有差異性,活動期顯著升高的細胞因子IL-6、TNF-α等可在一定程度上評判眼病活動分期。 作為甲狀腺相關(guān)眼病中受累組織之一的淚腺,在發(fā)病及眼病進展中的作用目前尚不明確。影像學(xué)及病理學(xué)研究證實,TAO患者淚腺腫大,淚腺組織淋巴細胞浸潤和脂肪增生,與球后組織病理改變相似。Eckstein等發(fā)現(xiàn)正常淚腺腺泡細胞表面表達促甲狀腺素受體(Thyroitropin receptor, TSHR),而TSHR是導(dǎo)致甲狀腺和眼眶發(fā)病的重要交叉抗原。由此,研究者提出假說,淚腺腺泡細胞可能是TAO發(fā)病中的靶細胞之一 臨床上,TAO患者的眼表癥狀突出,包括結(jié)膜充血水腫、流淚或淚液分泌減少、干澀異物感等,與干眼癥相似,亦有研究證實TAO患者淚膜破裂時間縮短,眼表疾病指數(shù)升高,干眼癥狀明顯,引起臨床醫(yī)生和學(xué)者們的重視。既往的研究認為眼表癥狀的出現(xiàn)與眼球突出度增加、瞼裂增寬,淚液蒸發(fā)加速導(dǎo)致淚液滲透壓增加相關(guān),但是近來的研究證據(jù)顯示可能淚腺也參與TAO的干眼癥狀的發(fā)生。 淚腺是眼分泌性免疫系統(tǒng)的主要組織,含有多種淋巴細胞和免疫活性成分,對眼表的保護作用和免疫功能的發(fā)揮主要依靠分泌淚液實現(xiàn)。淚液中含有復(fù)雜的細胞因子成分,可調(diào)節(jié)多種細胞功能,其濃度變化可引起一系列炎癥反應(yīng),導(dǎo)致干眼等眼表癥狀,可作為疾病恢復(fù)的信號和干眼癥等眼表疾病的標志物。 淚腺腺泡細胞與球后成纖維細胞表面同樣表達TSHR,并出現(xiàn)與活動期球后組織相似的病理改變,由此,我們提出假設(shè)：淚腺是否與球后組織一樣存在細胞因子網(wǎng)絡(luò)的失衡?而作為淚腺分泌物,淚液細胞因子水平是否可以間接反映淚腺炎癥反應(yīng)和眼病活動性?目前國內(nèi)外此類研究極少,甲狀腺相關(guān)眼病患者淚液細胞因子表達情況尚不明確。對TAO患者淚液細胞因子譜的研究有助于進一步從非創(chuàng)性角度去初步探討淚腺在甲狀腺相關(guān)眼病發(fā)病中的作用,對不同活動分期TAO細胞因子濃度的比較,有助于尋求活動分期的可能指標,為臨床治療提供可靠依據(jù)。 液相芯片是基于美國Luminex公司xMAP(flexible multianalyte profiling)技術(shù)的新型芯片技術(shù)平臺,具有高通量、高靈敏度、高特異性的特點,非常適合于同時檢測微量淚液樣本中的多個細胞因子。對多個細胞因子水平進行檢測與評價比檢測單個細胞因子更能反應(yīng)疾病發(fā)生與發(fā)展的整體變化。 本研究將應(yīng)用液相芯片技術(shù)分析不同活動分期TAO淚液中IL-6、IL-10、TNF-α、IFN-γ、IL-17、IL-8、和IP-10的水平,了解TAO患者淚液細胞因了的表達情況。并隨訪觀察球后放射治療前后各細胞因子水平的變化,進一步探討淚腺、淚液炎癥因子在TAO發(fā)病機制中的可能作用,并尋求甲狀腺相關(guān)眼病活動分期的可能指標。 研究目的 利用液相芯片技術(shù)檢測不同分期TAO淚液中5種細胞因子和2中趨化因子水平,了解TAO患者淚液細胞因子的表達情況,并尋求活動分期的可能指標。 研究方法 1、研究對象：連續(xù)收集2011.01-2012.02在南方醫(yī)院內(nèi)分泌科和南方醫(yī)科大學(xué)第三附屬醫(yī)院內(nèi)分泌科就診的近3個月內(nèi)未行大劑量激素沖擊和其他免疫抑制劑治療的中重度TAO患者47例,按CAS評分標準將其分為活動期27例(CAS≥3)和穩(wěn)定期20例(CAS3)；同期連續(xù)收集正常對照組10例。收集非刺激性淚液,采用LiquiChipTM液相芯片技術(shù)檢測淚液中IL-6、IL-10、TNF-α、IFN-γ、IL-17、IL-8和IP-10的水平 2、統(tǒng)計方法：采用SPSS13.0統(tǒng)計軟件進行數(shù)據(jù)分析。符合正態(tài)分布的計量資料以X+SD表示,偏態(tài)分布的計量資料以中位數(shù)表示。正態(tài)分布的各組間計量資料的分析采用One-way ANOVA,當(dāng)P≥0.05時,認為方差齊,用LSD法作進一步的多重比較。方差不齊性時,用Welch法校正,并用Dunnett T3法進一步作多重比較。偏態(tài)分布的計量資料和等級資料的組間比較采用非參數(shù)檢驗,三組間淚液細胞因子濃度比較采用Kruskal-Wallis H檢驗,P0.05為差異有統(tǒng)計學(xué)意義,進一步組間比較采用Wilcoxon符號秩檢驗,檢驗水準采用校正后P值,以P0.017為差異有統(tǒng)計學(xué)意義。TAO患者中淚液細胞因子與促甲狀腺素受體抗體(thyrotropin receptor antibody,TRAb)和CAS評分的相關(guān)性分析用spearman相關(guān)分析,P0.05為差異有統(tǒng)計學(xué)意義。 研究結(jié)果 1.TAO與正常人淚液細胞因子表達情況 細胞因子IL-6、趨化因子IP10、IL-8在所有57份標本中取得結(jié)果(檢出率為100%),濃度范圍分別為0.32～1583.15pg/ml、58.26～19404.08pg/ml、6098.18-24034pg/ml。TNF-α和IL-10在54份標本中檢出(檢出率為94.7%),濃度范圍分別為0.25～121.23pg/ml、0.33～108.82pg/ml。IL-17僅在1例標本中檢出(檢出率為1.8%),IFN-γ在所有的標本中均未檢出. 2、TAO組與正常人淚液細胞因子濃度比較 與正常組相比較,TAO患者淚液IL-6、IL-10、IL-8和IP-10水平顯著升高,差異具有統(tǒng)計學(xué)差異(P0.001P=0.046P=0.002P=0.026),而TNF-α在TAO和正常組間無顯著差異(P=0.664) 3、不同TA0分組間淚液細胞因子濃度比較 IL-6：與正常組比較,活動期TAO組和穩(wěn)定期TAO組淚液IL-6濃度均明顯升高,差異有統(tǒng)計學(xué)意義。(P0.001P=0.003),活動期TAO組和穩(wěn)定期TAO間比較,差異具有統(tǒng)計學(xué)意義,活動期TAO組IL-6顯著高于穩(wěn)定期TAO組(P=0.0010.017)。 IL-10：與正常組相比較,活動期TAO淚液IL-10濃度顯著升高,差異有統(tǒng)計學(xué)意義(P0.001)；活動組與穩(wěn)定組比較差異具有統(tǒng)計學(xué)意義,活動期TAO IL-10濃度顯著高于穩(wěn)定期TAO(P=0.009)；穩(wěn)定期TAO組與正常組間比較差異無統(tǒng)計學(xué)意義(P=0.705) TNF-α：與正常組相比較,活動期TAO組和穩(wěn)定期TAO組淚液TNF-α濃度無顯著差異(P=0.353P=0.555),活動期TAO組與穩(wěn)定期TAO組比較,差異具有統(tǒng)計學(xué)差異(P=0.006) IL-8：與正常組相比較,活動期TAO淚液IL-8濃度顯著升高,差異有統(tǒng)計學(xué)意義(P0.001)；活動組與穩(wěn)定組比較差異無統(tǒng)計學(xué)意義(P=0.017)穩(wěn)定期TAO組與正常組間比較差異無統(tǒng)計學(xué)意義(P=0.044) IP-10：與正常組相比較,活動期TAO淚液IP10濃度顯著升高,差異有統(tǒng)計學(xué)意義(P=0.004)；活動組與穩(wěn)定組比較差異具有統(tǒng)計學(xué)意義,活動期TAOIP10濃度顯著高于穩(wěn)定期TAO(P=0.004)；穩(wěn)定期TAO組與正常組間比較差異無統(tǒng)計學(xué)意義(P=0.307) 4、TA0患者淚液細胞因子與CAS、TRAb的相關(guān) TAO患者淚液IL-6、IL-10、TNF-a、IL-8、IP10與活動性評分CAS呈不同程度相關(guān)性(r=0.565,0.415,0.453,0.385,0.469；P0.001,0.005,0.002,0.008,0.001) TAO患者淚液IL-6、TNF-α、IL-8、IP10與TRAb濃度呈不同程度相關(guān)性(r=0.477,0.325,0.314,0.365；P=0.002,0.032,0.032,0.012),IL-10濃度與TRAb無顯著相關(guān)(P0.05) 結(jié)論 1、甲狀腺相關(guān)眼病影響淚液細胞因子水平,與正常人比較,TAO患者淚液細胞因子IL-6、IL-10、IL-8和IP10顯著濃度升高。 2、不同活動分期TAO淚液細胞因子表達具有差異性,活動期TAO淚液IL-6、IL-10和IP10濃度顯著高于穩(wěn)定期,并與眼病活動性評分CAS呈正相關(guān),淚液IL-6、IL-10和IP10濃度在一定程度上可作為活動分期的評判指標。 研究目的 縱向觀察并比較甲狀腺相關(guān)眼病患者淚液中5種細胞因子和2種趨化因子水平在球后放射治療前后的變化,旨在了解其動態(tài)變化,進一步明確淚液細胞因子在判斷眼病活動分期中的意義。 材料與方法 1.研究對象：第一章中活動期TAO組中接受直線加速器球后放射治療、并完成治療后3個月隨訪的14例TAO患者,男2例,女12例,平均年齡(39.00+11.17)歲。治療后3月收集非刺激性淚液,采用LiquiChipTM液相芯片技術(shù)檢測淚液中IL-6、IL-10、TNF-α、IFN-γ、IL-8、IP-10和IL-17的水平 2.治療方法 球后放射使用美國VARIAN2100C型直線加速器。分次照射劑量為200cGy,總劑量2000cGy(10次/2周),在模擬機下定位,照射野大小一般為4cmx4cm,機架角度偏轉(zhuǎn)3°～5°,以避開對側(cè)晶體,療程為2周。治療開始時同時口服強的松30mg,1/日,治療結(jié)束后逐漸減量至停藥。 3.臨床相關(guān)指標 所有入組患者完成治療前和治療3月后臨床活動評分(CAS),NOSPECS分級、突眼度及瞼裂寬度測量,同時抽血進行甲狀腺功能和TRAb的檢測。CAS、突眼度、瞼裂寬度的測定由2名指定的專業(yè)人員獨立完成,測量結(jié)果意見一致。 4.統(tǒng)計方法：采用SPSS13.0統(tǒng)計軟件進行數(shù)據(jù)分析。計量資料以X+SD或者中位數(shù)表示。治療前后CAS、突眼度、瞼裂寬度和TRAb濃度比較采用配對t檢驗,治療前后淚液細胞因子濃度比較采用兩相關(guān)樣本非參數(shù)檢驗,P0.05為差異有統(tǒng)計學(xué)意義。 研究結(jié)果 1、球后放射治療前后臨床指標比較 與球后放射治療前比較,治療后3月后CAS評分、TRAb、瞼裂寬度和突眼度均顯著下降,差異具有統(tǒng)計學(xué)意義(P0.001P=0.001P=0.005P=0.009)見表2-1 2、治療前后淚液細胞因子濃度比較 治療后TAO淚液細胞因子IL-6濃度顯著下降,差異具有統(tǒng)計學(xué)意義(P=0.041)其余細胞因子IL-10、TNF-α、IL-8和IP10濃度無顯著下降(P=0.950P=0.074P=0.096P=0.510) 結(jié)論 1、球后放射治療后TAO淚液IL-6濃度顯著下降。機制可能為球后放療減輕淚腺淋巴細胞浸潤和細胞因子IL-6的合成分泌,從而降低淚液IL-6的濃度。 2、球后放射治療后TAO患者眼病活動性評分、突眼度和瞼裂寬度顯著下降,證實球后放療是治療活動期中重度TAO的有效方法,
[Abstract]:Research background
Thyroid associated ophthalmopathy (TAO) is an ocular disease closely related to the autoimmune disease of the thyroid gland, often accompanied by the occurrence of Graves'disease (Graves'disease, GD), which is also known as Graves ophthalmopathy (Graves ophthalmopathy, GO). Its ocular manifestations are characterized by obvious eye symptoms, only eye discomfort in the light. Eyelid retraction, severe eye exophthalmos, diplopia and even loss of vision. There is no satisfactory treatment at present.
The pathogenesis of TAO is not fully understood. It is generally acknowledged that the "common antigen theory", that is, the expression of the cross antigen of the extraocular myocutaneous fibroblasts and the thyroid gland, leads to the infiltration of active lymphocytes in the orbit, the release of various cytokines, the action of the orbital tissue, the inflammation reaction in the orbit, and the secretion of glycosaminoglycan (Glycos) in the fibroblasts. Aminoglycans, GAG), a large number of hydrophilic GAG accumulation leads to a series of clinical symptoms such as eyeball protrusion, in which TSHR may play an important role in the pathogenesis of TAO. The post ball fibroblast, lymphocyte and its secreted cytokines play a key role in the development of TAO, and have also become more important. Previous studies have shown that the expression of cytokines in the peripheral blood and post - ball tissues of TAO in different stages is different. The cytokine IL-6, TNF- alpha, which are significantly higher in the active stage, can be used to judge the stage of eye disease to a certain extent.
The role of lacrimal gland, one of the affected tissues of the thyroid associated ophthalmopathy, is not clear in the progression of the disease and ophthalmopathy. Imaging and pathological studies have confirmed that the lacrimal gland enlargement, lymphocytic infiltration of lacrimal gland tissue, and fatty hyperplasia in TAO patients are similar to.Eckstein in the pathological changes of the tissue, and the surface of the normal lacrimal gland acinar cell surface is found. Thyroitropin receptor (TSHR), and TSHR is an important cross antigen that causes the thyroid and orbital diseases. Thus, the researchers hypothesized that lacrimal gland acinar cells may be one of the target cells in the pathogenesis of TAO.
Clinically, the ocular surface symptoms of TAO patients are prominent, including conjunctival congestion and edema, tears or tear secretion reduction, dry and foreign body sensation, similar to dry eye. Studies have confirmed that the tear film rupture time of the TAO patients is shortened, the eye surface disease index is increased, and the dry eye symptoms are obvious, which cause the attention of the clinicians and scholars. Appearance and exophthalmos increased, palpebral fissure widened and tear vaporization accelerated to increase lacrimal osmotic pressure, but recent evidence suggests that lacrimal glands may also be involved in the occurrence of dry eye symptoms in TAO.
Lacrimal gland is the main tissue of the secretory immune system of the eye. It contains a variety of lymphocytes and immune active components. The protection and immune function of the eye surface mainly depend on the secretion of tears. The tears contain complex cytokine components, which can regulate a variety of cell functions. The concentration changes can cause a series of inflammatory reactions, leading to a series of inflammatory reactions. Dry eye and other ocular surface symptoms can be used as markers for disease recovery and ocular surface diseases such as dry eye.
The lacrimal gland acinar cells also express TSHR on the surface of the post ball fibroblasts, and appear to be similar to those of the active tissue in the active stage. Therefore, we hypothesized that if the lacrimal gland is like the post ball tissue, there is an imbalance in the cytokine network. As a lacrimal gland secretion, whether the level of lacrimal fluid cytokine can indirectly reflect the mastitis There are few such studies at home and abroad. The expression of tear cytokine in patients with thyroid related ophthalmopathy is not clear. The study of the tear cytokine spectrum of TAO patients is helpful to further explore the role of lacrimal gland in the pathogenesis of thyroid related ophthalmopathy from the noninvasive angle, and to the different stages of TAO The comparison of cytokines concentration can help to find possible indicators of activity staging and provide reliable evidence for clinical treatment.
Liquid chip is a new chip technology platform based on the xMAP (flexible multianalyte profiling) technology of Luminex company in the United States. It is characterized by high throughput, high sensitivity and high specificity. It is very suitable for the simultaneous detection of multiple cytokines in microtear samples. Detection and evaluation of multiple cytokine levels are more than single detection. Cytokines can better reflect the overall changes in disease occurrence and development.
This study will use liquid chip technology to analyze the expression of IL-6, IL-10, TNF- a, IFN-, IL-17, IL-8, and IP-10 in TAO tears of different activity stages, and to investigate the changes in the level of cell factors in the patients with TAO after the post ball radiotherapy, and further explore the pathogenesis of lacrimal gland and tear inflammatory factors in TAO. The possible role of the mechanism and the possible indicators of thyroid related ophthalmopathy activity stages.
research objective
The level of 5 cytokines and chemokines in different stages of TAO tears were detected by liquid chip technology, and the expression of tear cytokine in TAO patients was understood and the possible index of activity stage was sought.
research method
1, subjects: 47 cases of moderate to severe TAO patients who had not been treated with large dose of hormone impact and other immunosuppressive agents in the Department of endocrinology in the Department of endocrinology of southern hospital and the Affiliated Hospital of Southern Medical University for nearly 3 months, were divided into 27 cases (CAS > 3) and 20 cases of stability (CAS > 3) according to the CAS score (CAS). CAS3); 10 cases of normal control group were collected continuously in the same period. Non irritant tears were collected and LiquiChipTM liquid chip technique was used to detect IL-6, IL-10, TNF- alpha, IFN- gamma, IL-17, IL-8 and IP-10 in tears.
2, statistical method: using the SPSS13.0 statistical software to analyze the data. The measurement data conforming to the normal distribution are expressed in the X+SD. The measurement data of the partial distribution are expressed in the median. One-way ANOVA is used for the analysis of the measurement data of the normal distribution. When P is more than 0.05, the variance is homogeneous and the LSD method is used for further multiple comparison. Variance is not the same. At the time of homogeneity, the Welch method was corrected and the Dunnett T3 method was used for multiple comparison. The measurement data of the partial distribution and the grade data were compared with the non parameter test. The concentration of tear cell factors between the three groups was compared with the Kruskal-Wallis H test, and the P0.05 was statistically significant, and the further group was compared with the Wilcoxon sign test. The test level was corrected by the corrected P value, and the correlation analysis of tear cytokine and thyrotropin receptor antibody (thyrotropin receptor antibody, TRAb) and CAS score in.TAO patients with statistically significant difference in P0.017 was statistically significant, and P0.05 was of significant difference.
Research results
Expression of 1.TAO and normal human tear cytokine
The results of cytokine IL-6, chemokine IP10, IL-8 were obtained in all 57 specimens (the detection rate was 100%), the concentration range was 0.32 to 1583.15pg/ml, 58.26 to 19404.08pg/ml, 6098.18-24034pg/ml.TNF- alpha and IL-10 were detected in 54 samples (detection rate was 94.7%), the concentration range was 0.25 to 121.23pg/ml, 0.33 to 108.82pg/ml.IL-17 only. The detection rate was 1.8% in 1 specimens, and IFN- gamma was not detected in all specimens.
2, TAO group and normal human tear cytokine concentration comparison
Compared with the normal group, the levels of IL-6, IL-10, IL-8 and IP-10 in TAO patients were significantly higher, and the difference was statistically significant (P0.001P=0.046P=0.002P=0.026), but there was no significant difference between the TNF- alpha and the normal group (P=0.664).
3, comparison of the concentration of tear cell factors between different TA0 groups
IL-6: compared with the normal group, the tear IL-6 concentration in the active phase TAO group and the stable period TAO group increased significantly, and the difference was statistically significant. (P0.001P=0.003), the difference was statistically significant between the active TAO group and the stable phase TAO, and the IL-6 in the active stage TAO group was significantly higher than that of the stable TAO group (P=0.0010.017).
IL-10: compared with the normal group, the concentration of IL-10 in the active TAO tears was significantly increased, the difference was statistically significant (P0.001), the difference between the active group and the stable group was statistically significant, and the concentration of TAO IL-10 in the active phase was significantly higher than that of the stable TAO (P=0.009), and there was no significant difference between the group of stable TAO and the normal group (P=0.705).
TNF- alpha: compared with the normal group, there was no significant difference in the TNF- alpha concentration between the active TAO group and the stable phase TAO group (P=0.353P=0.555). The difference between the active TAO group and the stable TAO group was statistically significant (P=0.006).
IL-8: compared with the normal group, the concentration of IL-8 in TAO tear was significantly higher in active phase (P0.001), and there was no significant difference between the active group and the stable group (P=0.017), and there was no statistical difference between the TAO group and the normal group (P=0.044).
IP-10: compared with the normal group, the concentration of IP10 in the active TAO tears was significantly increased, the difference was statistically significant (P=0.004). The difference of the activity group and the stable group was statistically significant, and the concentration of TAOIP10 in the active phase was significantly higher than that of the stable phase TAO (P=0.004), and there was no statistical difference between the stable TAO group and the normal group (P=0.307).
4, the correlation between tear cytokine and CAS, TRAb in TA0 patients
The IL-6, IL-10, TNF-a, IL-8, IP10 of TAO patients were related to the activity score (r=0.565,0.415,0.453,0.385,0.469; P0.001,0.005,0.002,0.008,0.001) in varying degrees.
The concentrations of IL-6, TNF-, IL-8, IP10 and TRAb in TAO patients were correlated (r=0.477,0.325,0.314,0.365; P=0.002,0.032,0.032,0.012) in varying degrees (r=0.477,0.325,0.314,0.365; P=0.002,0.032,0.032,0.012). There was no significant correlation between IL-10 concentration and TRAb (P0.05).
conclusion
1, thyroid associated ophthalmopathy affected the level of lacrimal cytokine. Compared with normal subjects, the levels of IL-6, IL-10, IL-8 and IP10 increased significantly in TAO patients.
2, the expression of tear cytokine in TAO with different activity stages was different. The activity stage TAO tear IL-6, IL-10 and IP10 concentration were significantly higher than that in the stable stage, and were positively correlated with the activity score of ophthalmopathy CAS. The concentration of IL-6, IL-10 and IP10 in tear could be used as the evaluation index of the activity stage.
research objective
Longitudinal observation and comparison of the changes of 5 cytokines and 2 chemokine levels in the tears of patients with thyroid related ophthalmopathy before and after the post - ball radiotherapy are designed to understand the dynamic changes and to further clarify the significance of tear cell factors in judging the stage of eye disease.
Materials and methods
1. subjects: in the first chapter, in group TAO, group TAO was treated with linear accelerator post ball radiotherapy, and 14 cases of TAO patients were followed up for 3 months after treatment. 2 men, 12 women, and average age (39.00+11.17) years. After treatment, non irritant tears were collected in March, and IL-6, IL-10, TNF- a, IFN- gamma, IL-8 in tears were detected by LiquiChipTM liquid chip technology. The level of IP-10 and IL-17
2. treatment methods
After the ball, the United States VARIAN2100C linear accelerator was used. The dose of fractional irradiation was 200cGy, the total dose was 2000cGy (10 times /2 weeks). The size of the irradiated field was generally 4cmx4cm, the angle of the frame was 3 to 5 degrees, to avoid the contralateral crystal for 2 weeks. At the beginning of the treatment, the oral prednisone 30mg, 1/ day, gradually after the treatment ended, gradually after the treatment ended. Reduce to withdrawal.
3. clinical related indexes
The clinical activity score (CAS), NOSPECS classification, exophthalmos and palpebral fissure width were measured before and after March, and the measurement of thyroid function and TRAb for.CAS, exophthalmos and palpebral fissure width were determined by 2 designated professionals.
4. statistical method: using SPSS13.0 statistical software for data analysis. The measurement data were expressed in X+SD or median. CAS, exophthalmos, palpebral fissure width and TRAb concentration were compared before and after treatment by paired t test. The concentration of tacrimal cytokine before and after treatment was compared with two related samples, and P0.05 was statistically significant.
Research results
1, comparison of clinical indexes before and after post ball radiotherapy
Compared with post - ball radiotherapy, the CAS score after March after treatment, TRAb, the width of cleft palpebral and the degree of exophthalmos were significantly decreased, and the difference was statistically significant (P0.001P=0.001P=0.005P=0.009) in table 2-1

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R581.1;R771.3

【參考文獻】

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