干燥综合征合并桥本甲状腺炎的临床特点及相关因素分析

Clinical Features and Analysis of Related Factors for Hashimoto's Thyroiditis in Patients with Sjgren's Syndrome

目的分析干燥综合征(SS)合并桥本甲状腺炎(HT)患者的临床表现、特点以及相关因素。方法回顾性分析32例SS合并HT住院患者和24例随机抽样的SS对照组患者的资料。结果合并HT的SS患者眼干、甲状腺增大及浆膜腔积液的发病率显著高于SS对照组。与SS对照组相比,SS合并HT患者血清甘油三酯水平显著增高,血清IgA及α1球蛋白比例显著降低。所有SS患者的血清C反应蛋白(CRP)与血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离甲状腺素(FT4)水平呈显著负相关,与促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(ATG)呈显著正相关;血清胆固醇水平与血清游离三碘甲状腺原氨酸(FT3)、FT4水平呈显著负相关,血糖水平与血清TSH、ATG水平呈显著负相关;血清IgG水平与血清T4、FT3水平呈显著正相关,血清C4水平与血清TSH、ATG及抗甲状腺髓过氧化酶抗体(ATM)水平呈显著负相关;血清α2球蛋白比例与血清T4呈显著正相关;血清γ球蛋白比例与血清ATG水平呈显著正相关。结论SS患者易合并HT,当SS患者临床出现眼干明显、甲状腺增大、浆膜腔积液,CRP、甘油三酯、胆固醇及γ球蛋白升高,血糖、IgA、IgG、CA、α1及α2球蛋白水平下降时,需警惕合并HT。

Objective To investigate the clinical features and the course of Hashimoto＇s thyroiditis （HT） in patients with Sjogren＇s syndrome （SS） and to analyze related factors. Methods 32 SS patients with HT and 24 SS patients without HT have been retrospectively analyzed. Results In 32 SS patients with HT, the rate of dry eye, thyroid enlargment and serous effusion was significantly higher than in control group （18/32 vs 7/24, P 〈 0.05, 8/32 vs 0/24, P 〈 0.01, 7/32 vs 0/24, P 〈 0.01）. The levels of serum triglyceride in SS patients with HT were significantly higher [（1.62 ± 0.72） mmol/L vs. （1.22 ± 0.69） retool/L, P 〈 0.05], and the levels of serum IgA and oLl-globulin was significantly lower than in the normol group [（2.14±1.09） g/L vs （2.97±0.96） g/L, P〈 0.05], [（3.41±0.75） % vs （6.80±6.63） %, P 〈 0.05]. The levels of serum C-reactive protein positively correlated with thyrotropic-stimulating hormone （TSH） and antithyroglobulin （ATG） and negatively correlated with triiodothyronine （T3）, thyroxine （T4） and free thyroxine （FT4）. The levels of serum cholesterol negatively correlated with free triiodothyronine （FT3） and FT4. The levels of blood glucose negatively correlated with TSH and ATG. The levels of serum IgG positively correlated with T4 and FT3. The levels of serum complement （C） 4 negatively correlated with TSH, ATG and ATM. The levels of serum α2-globulin positively correlated with T4. The levels of serum γ-globulin positively correlated with ATG. Conclusion There is a high risk of HT in patient with SS. The prevalence of HT in SS with dry eye, thyroid enlargement and serous effusion, higher levels of C-reactive protein, triglyceride, cholesterol and γ-globulin and lower levels of blood glucose, IgA, IgG, C4, M-globulin and α2-globulin is higher than that of SS patients without these features.