多发性硬化患者甲状腺功能的临床研究

发布时间：2018-05-14 14:28

本文选题：多发性硬化（MS） + 视神经脊髓炎（NMO）　；参考：《吉林大学》2014年硕士论文

【摘要】：多发性硬化（Multiple sclerosis，MS）是最常见的中枢神经系统脱髓鞘性疾病之一，自身免疫反应在其致病机制中发挥重要作用。视神经脊髓炎（Neuromyelitis optica，NMO）是一种以视神经和脊髓受累为主的炎性脱髓鞘疾病，部分临床特点与MS相似。在临床工作中发现，MS患者常合并其他自身免疫疾病，尤以甲状腺疾病居多。探明MS患者甲状腺功能情况，是研究MS患者甲状腺疾病易感性及其可能的潜在共同致病机制的基础。目的：检测MS和NMO患者甲状腺功能情况，分析其与患者性别、年龄、病程、神经功能缺失等方面的关系。方法：统计2012年3月至2013年9月于吉林大学第一医院神经内科住院治疗的MS急性期及NMO急性期患者资料，包括52例MS患者、29例NMO患者，，同时选取该院健康体检人员98例作为对照组，其年龄、性别及体检时间与研究患者相匹配。对所有研究对象进行甲状腺功能检测，包括甲状腺激素5项（T3、fT3、T4、fT4、TSH）及抗甲状腺自身抗体（Antithyroid antibody，ATA）2项（抗甲状腺过氧化物酶抗体TPOAb、抗甲状腺球蛋白抗体TGAb）。统计MS及NMO患者一般资料、临床资料及辅助检查结果，并分别对其入院时残疾情况进行扩展残疾状况评分量表（Expanded disability status scale，EDSS）评分。采用SPSS17.0软件对所有数据进行统计学分析。结果：（1）MS患者血清TSH、T3、fT4水平较健康对照组升高，其中TSH水平升高具有显著统计学意义（P0.05）；T4、fT3水平较健康对照组降低，但是无显著统计学差异（P0.05）。与对照组相比，MS组患者的ATA阳性率明显升高，差异具有显著统计学意义（P0.05）。（2）NMO患者血清TSH、T3水平较健康对照组升高，其中TSH水平升高具有显著统计学意义（P0.05）；T4、fT4、fT3水平较健康对照组降低，但是无显著统计学差异（P0.05）。与对照组相比，NMO组患者的ATA阳性率升高，但是无显著统计学差异（P0.05）。（3）MS和NMO患者合并甲状腺疾病组与不合并甲状腺疾病组比较，两组的性别、年龄、首次发病年龄、病程、EDSS评分及MRI病灶均无显著统计学差异（P0.05）。结论：MS及NMO患者更易合并亚临床甲状腺功能减低(Subclinicalhypothyroidism, SCH)，同时MS患者抗甲状腺自身抗体阳性率显著升高。建议MS及NMO患者常规进行甲状腺激素及抗甲状腺自身抗体水平检测，并定期复查。
[Abstract]:Multiple sclerosis (MS) is one of the most common demyelinating diseases in central nervous system. Autoimmune response plays an important role in the pathogenesis of multiple sclerosis. Neuromyelitis optica NMOis is a kind of inflammatory demyelinating disease mainly involving optic nerve and spinal cord, and some clinical characteristics are similar to that of MS. In clinical work, MS patients are often associated with other autoimmune diseases, especially thyroid diseases. The investigation of thyroid function in MS patients is the basis to study the susceptibility of MS patients to thyroid disease and its potential common pathogenetic mechanism. Aim: to detect thyroid function in patients with MS and NMO, and to analyze the relationship between thyroid function and sex, age, course of disease, nerve function loss and so on. Methods: from March 2012 to September 2013, the data of MS acute phase and NMO acute phase were analyzed in Department of Neurology, first Hospital of Jilin University, including 52 MS patients and 29 NMO patients. At the same time, 98 healthy persons were selected as the control group. The age, sex and time of the physical examination were matched with the patients in the study. Thyroid function was measured in all subjects, including 5 items of thyroid hormone (T3FT3FT3FT4) and 2 items of antithyroid autoantibody (antithyroid antibody ATAA) (antithyroid peroxidase antibody (TPOAbb), antithyroglobulin antibody (TGAbb). The general data, clinical data and auxiliary examination results of patients with MS and NMO were analyzed, and the extended disability status scale (EDSSs) was used to evaluate the disability status on admission. All the data were analyzed statistically by SPSS17.0 software. Results the serum levels of TSH T3 and FT4 in MS patients were significantly higher than those in healthy controls, and the level of TSH was significantly lower than that in the healthy controls (P 0.05), but there was no significant difference between the two groups (P 0.05). Compared with the control group, the positive rate of ATA in MS group was significantly higher than that in the control group, and the serum TSH T 3 level in the patients with MS was significantly higher than that in the healthy control group, and the level of TSH was significantly higher than that in the healthy control group. But there was no significant statistical difference (P 0.05). Compared with the control group, the positive rate of ATA in the NMO group was higher than that in the control group, but there was no significant difference between the two groups in terms of sex, age, age of the first onset. There was no significant difference in EDSS score and MRI lesion in course of disease (P 0.05). Conclusion the subclinical hypothyroidism and NMO are more likely to be associated with subclinical hypothyroidism in patients with MS and NMO, and the positive rate of anti-thyroid autoantibodies in MS patients is significantly higher than that in patients with MS. It is suggested that the thyroid hormones and anti-thyroid autoantibodies should be detected regularly in MS and NMO patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.51

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