IgG4相关性Graves病和桥本甲状腺炎患者的临床特征研究

发布时间：2018-03-11 14:28

  本文选题：IgG4　切入点：Graves病　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察IgG4相关性Graves病和桥本氏甲状腺炎的临床特点,指导认识和治疗IgG4相关性甲状腺疾病。方法:随机收集Graves病和桥本氏甲状腺炎患者。检测血清IgG4水平,按是否1.35g/L分为阳性组与阴性组。分析比较两组患者的年龄、性别、病程、证型分布、甲状腺功能、超声、药物治疗剂量、吸烟史、自身免疫性疾病家族史等。结果:(1)114名Graves病患者中10人(8.77%)为阳性,男性占20%。两组患者的年龄、BMI、FT3、FT4、TgAb及TPOAb水平、结节发生率、突眼率及AID家族史等均无统计学差异。伴高水平IgG4者,患者发病年龄相对较小(32.21±15.01y vs.33.87±13.64y,p=0.482),但无统计学意义。IgG4升高者Graves病病情更重,其TSH水平显著低于非IgG4升高者(0.29±0.83uIU/ml vs.3.09±14.90uIU/ml,p=0.013),伴有明显高于阴性组的TRAb水平(17.37± 13.61mIU/ml vs.9.13±12.04mIU/ml,p=0.017)及抗甲状腺药物(ATD)剂量(17.13±8.62mg vs.9.08±7.93mg,p=0.005),均有统计学差异。相关性分析中,IgG4水平与TRAb呈微弱正相关,r=0.239,p=0.016。对77例患者进行证候分析,结果显示无论IgG4阳性与否,患者均以心肝火旺证为主。(2)102名桥本患者,仅9人(8.82%)为阳性,均为女性。阳性组与阴性组在年龄、FT3、FT4、TSH、TgAb水平、结节发生率、AID家族史等方面无统计学差异。TPOAb水平显著高于阴性组(1300 ±0U/ml vs.912.21±520.61U/ml,p=0.029)。然而,相关性分析显示IgG4水平与TPOAb水平无相关性,r=0.001,P=0.989。阳性组甲减程度更重,LT4替代剂量显著高于阴性组(58.93±48.80ug vs.26.36±37.62ug,p=0.049)。对68例桥本患者进行证候分析,结果显示阳性以痰瘀互结型为主,但无人表现为脾肾阳虚证,阴性者以痰瘀互结证为主,其次为脾肾阳虚证。结论:IgG4阳性Graves病患者病情重于阴性者,所需用药剂量更大,且病程中易反复,纤维化更为严重。临床上遇到病情易反复、易复发者或病情严重者,应考虑检测血清IgG4水平,必要时加用糖皮质激素治疗。对于TRAb水平较高者,注意检测IgG4水平,积极控制甲功水平,甲功恢复后TRAb水平仍居高不下者考虑加用糖皮质激素。IgG4阳性的桥本患者甲减程度更为严重,临床上对于TPOAb超高的桥本患者可行血清IgG4检测,.IgG4水平升高时可结合临床症状,纤维化不严重、无明显肿胀或压迫症状时无需小剂量糖皮质激素干预,出现上述表现时排除激素禁忌后立即予大剂量激素治疗,短暂强化后再改为小剂量维持。
[Abstract]:Objective: to observe the clinical characteristics of IgG4 associated Graves disease and Hashimoto's thyroiditis, and to guide the understanding and treatment of IgG4 associated thyroid disease. Methods: the patients with Graves's disease and Hashimoto's thyroiditis were randomly collected and the serum IgG4 levels were measured. According to whether 1.35g / L was divided into positive group and negative group, the age, sex, course of disease, distribution of syndromes, thyroid function, ultrasound, dosage of drug therapy, smoking history were analyzed and compared between the two groups. Results among the 114 patients with Graves's disease, 10 (8.77) were positive, and 20 were male. There was no significant difference in the levels of TGAb and TPOAb, the incidence of nodules, the rate of exophthalmos and the family history of AID between the two groups. There was no significant difference in the incidence of nodules, the rate of exophthalmos and the family history of AID. The age of onset was 32.21 卤15.01y vs.33.87 卤13.64yd 0.482g, but no significant increase of IgG4 was found in patients with Graves disease. The level of TSH was significantly lower than that of the patients without elevated IgG4 (0.29 卤0.83u / ml vs.3.09 卤14.90u vs.3.09 卤14.90uIUP / ml 0.013), and the level of TRAb was 17.37 卤13.61mIUP / ml vs.9.13 卤12.04mIUP / ml (0.017) and the dose of antithyroid drug ATD was 17.13 卤8.62mg vs.9.08 卤7.93mgp0.005.There was a statistical difference between the level of IgG4 and TRAb in the correlation analysis. 77 patients were analyzed for syndromes, The results showed that no matter whether IgG4 was positive or not, 102 patients with heart-liver-fire flourishing syndrome, only 9 patients were positive, all of them were female. There was no significant difference in nodule incidence and family history. TPOAb level was significantly higher than that in negative group (1 300 卤0 U / ml vs.912.21 卤520.61 U / ml vs.912.21 卤0. 029 U / ml). Correlation analysis showed that there was no correlation between IgG4 level and TPOAb level. The degree of hypothyroidism in positive group was significantly higher than that in negative group (58.93 卤48.80 ug vs.26.36 卤37.62 ug vs.26.36 卤37.62 ug vs.26.36 0.049). However, none of the patients showed deficiency of spleen and kidney yang, the negative cases were mainly characterized by phlegm and blood stasis, followed by deficiency of spleen and kidney yang. Conclusion the patients with Graves disease with positive IgG4 were more serious than those with negative disease, and the dosage needed was higher, and it was easy to repeat in the course of disease. Fibrosis is more serious. In patients who are prone to relapse, relapse or severe disease, we should consider testing serum IgG4 level, and use glucocorticoid if necessary. For those with higher TRAb level, we should pay attention to detecting IgG4 level. Positive control of the level of thyroid function, after the recovery of the TRAb level is still high, considering the use of glucocorticoid. IgG4 positive patients with more severe hypothyroidism. In clinical practice, the elevated serum IgG4 level in patients with high TPOAb can be combined with clinical symptoms, fibrosis is not serious, and there is no need for low dose glucocorticoid intervention when there is no obvious swelling or compression. High dose hormone therapy was given immediately after hormone taboo was removed, and then changed to low dose maintenance after brief enhancement.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581

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相关期刊论文 前10条

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