系统性红斑狼疮合并桥本氏甲状腺炎的临床分析

发布时间：2018-07-08 11:28

  本文选题：系统性红斑狼疮 + 桥本氏甲状腺炎　； 参考：《昆明医科大学》2016年硕士论文

【摘要】：目的 研究桥本氏甲状腺炎(Hashimoto's Thyroiditis HT)在系统性红斑狼疮(systemic lupus erythematosus SLE)的发病率,探讨两种疾病伴发时的临床和实验室的特点,指导临床上SLE伴发HT的诊断与治疗。方法回顾性表格记录、电话回访方法,研究昆明医科大学第二、一附属医院1029例SLE患者,按试验设计分为3组,A组：80例SLE合并甲状腺球蛋白抗体(Thyroglobulin Antibodies, TgAb),甲状腺过氧化物酶抗体(Thyroid Peroxidase Antibodies, TPOAb)异常但未达到桥本氏甲状腺炎的诊断标准(后续的住院资料或电话回访,这80例SLE患者的TgAb、TPOAb通过治疗半年后转阴性)；B组：29例SLE合并HT(后续的住院资料或电话回访,这29例SLE患者的TgAb、 TPOAb通过治疗半年后仍阳性且甲状腺B超改变)；C组：从920例SLE且TgAb、 TPOAb正常的患者中按同时住院时间、性别1：1筛查出109例SLE患者为对照组,抗核抗体谱、泌尿系统、神经系统、血液系统、肝、肾功能、疾病活动评分的指标特点。计数资料用χ2检验,正态分布的计量资料用方差分析,偏态分布的计量资料用秩和检验,筛选出有统计学意义的单因素,然后使用多因素二分类Logistic回归分析发现SLE合并HT的独立危险因素。结果1029例SLE患者中,29例合并桥本甲状腺炎,发病率为2.8%。三组的线粒体M2阳性率分别为(18.7%、24.1%、6.08%,P0.05),口腔溃疡发生率(8.75%、27.5%、8.69%,P0.05),红细胞计数减少率(21.3%、17.2%、33.9%,P0.05),血红蛋白水平减少率(25%、38%、43.4%,P0.05),TGAB水平升高[4.01(3.10-5.50),6.10(3.40-103.54),(0.00),P0.05],TPOAb水平升高(曾用名为TMAb)[3.75(2.70-5.50),6.00(3.30-126.50),(0.00),P0.05],T4[0.00,0.00(0.00-5.20),0.00,P0.05],TSH水平[0.00,0.00(0.00-9.80),0.00,P0.05],FT3水平[0.00,0.00(0.00-1.46),0.00,P0.05]虽然统计学有意义但FT3都在正常范围内,临床无意义。FT4水平下降[0.00(0.00-0.75),0.00(0.00-1.46),0.00,P0.05],尿脓细胞数(1.70±0.05,0.26±0.14,0.57±0.12,P0.05)、球蛋白水平升高(30.27±5.91,34.23±10.67,32.86±7.85,P0.05)、高密度脂蛋白(1.74±0.72,2.36±0.96,1.73±0.07,P0.05)采用二分类Logistic回归分析SSA、SSB、RNP抗体、红细胞、血红蛋白均有统计学差异(P0.05),其中SSB阳性率,0R=6.43；血红蛋白减少率最大OR=0.45。结论1、SLE合并HT发病平均年龄大,SLE合并HT占SLE患者的2.8%。2、SLE合并HT时血液系统受累减少,其中SSA抗体是保护性因素,RNP抗体、SSB抗体是危险因素。3、HT在SLE患者的发病率与SLE的活动期无关。
[Abstract]:Objective to study the incidence of Hashimotos thyroiditis (Thyroiditis HT) in systemic lupus erythematosus (SLE), and to explore the clinical and laboratory features of the two diseases in order to guide the diagnosis and treatment of HT. Methods 1029 patients with SLE in the second, first affiliated hospital of Kunming Medical University were studied by retrospective tabular record and telephone return visit. According to the experimental design, group A was divided into three groups: group A: 80 SLE patients with Thyroglobulin Antibodies (TgAb), abnormal thyroid peroxidase antibodies (TPOAb) but not up to the diagnostic criteria of Hashimoto's thyroiditis. The TgAb-TPOAb of the 80 SLE patients turned negative after half a year treatment) Group B: 29 patients with SLE complicated with HT (follow-up hospitalization or telephone visit, 29 SLE patients TgAb, TPOAb are still positive after six months of treatment and thyroid B ultrasound changes); Group C: 109 SLE patients were screened as control group according to the time of hospitalization in 920 SLE patients with normal TgAband TPOAb. The antinuclear antibody spectrum, urinary system, nervous system, blood system, liver and kidney function were selected as control group. Index characteristics of disease activity score. The counting data were tested by 蠂 ~ 2, the measurement data of normal distribution by ANOVA, the metrological data of skewness distribution by rank sum test, and the single factor with statistical significance was screened out. Then multiple factor two classification logistic regression analysis was used to find the independent risk factors of SLE complicated with HT. Results there were 29 cases with Hashimoto's thyroiditis in 1029 cases, the incidence was 2.8%. 涓夌粍鐨勭嚎绮掍綋M2闃虫，

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