Association between intravenous pulse-therapy with immunosuppressant for Graves' ophthalmopathy and changes of peripheral blood T cell subgroup

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(P0.05).Compared with before treatment,the degrees of exophthalmos and exophthalmos activity were significantly lowered after treatment(P0.05);the thyrotropin receptor antibodies(TRAb),thyroid peroxidase(TPOAb),peripheral blood NK cells,CD3+ T lymphocytes,and CD8+ T lymphocytes were significantly reduced after treatment(P0.05);the ratio of CD4+/CD8+ was increased after the treatment(P0.05).The degrees of exophthalmos,exophthalmos activity and levels of CD3+ T lymphocytes decreased more significantly in group B than in group A(P0.05).The ratio of CD4+/CD8+ increased more significantly in group B than in group A(P0.05).Before treatment the counts of CD4+ T lymphocytes were markedly different between the effective,moderately effective,and the ineffective group(P0.05).Significant differences in TRAb,TPOAb,CD3+,CD8+ cells were found among the 3 groups after treatment.(P0.05).CD4+ T lymphocytes and CD4+/CD8+ ratio were significantly higher after treatment compared with those before treatment(P0.05).Significant differences in TRAb,CD4+,CD8+ T lymphocytes,CD4+/CD8+ ratio were found among 3 groups(P0.05).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.