类风湿关节炎伴甲状腺功能异常临床分析

Clinical analysis of hypothyroidism in patients with rheumatoid arthritis

目的:研究类风湿关节炎伴发甲状腺功能异常的情况。方法:确诊为类风湿关节炎患者40例为观察组,健康体检者40例为对照组。检测常规的实验室检查项目、免疫学指标及甲状腺功能、促甲状腺激素刺激激素和自身甲状腺抗体,同时将类风湿关节炎患者甲状腺功能与类风湿因子、免疫球蛋白、抗核抗体、血沉、丙种反应性蛋白水平进行相关性分析。结果:观察组有7例(17.5%)甲状腺功能异常,其中甲状腺功能减退2例,桥本氏甲状腺炎1例,甲状腺功能正常病态综合征4例。对照组甲状腺功能异常者2例(5%),均为甲状腺功能正常病态综合征。观察组甲状腺微粒体抗体升高,促甲状腺激素刺激激素升高,而三碘甲状腺原氨酸、游离三碘甲状腺原氨酸水平较对照组降低,差异有统计学意义(P<0.05)。观察组甲状腺功能与类风湿因子、免疫球蛋白、补体、抗核抗体、血沉、丙种反应性蛋白水平无显著相关性。结论:类风湿关节炎伴发甲状腺功能异常并不少见,应予重视。

Objective To evaluate the prevalence of thyroid dysfunction in patients with rheumatoid arthritis. Methods Forty patients with rheumatoid arthritis and 40 healthy controls received routine laboratory and serologic immune examination, plus serum levels of thyroxine, triiodothyronine, free triiodothyronine and thyroxine, thyroid stimulating hormone, and autoantibodies against thyroid. The correlations in the patients with rheumatoid arthritis were analyzed between thyroid function and the level of rheumatoid factor, immunoglobulin, anti-nuclear antibody, erythrocyte sedimentation rate and C-reactive protein. Results Of the 40 patients with rheumatoid arthritis, 7（17.5%）had evidence of thyroid dysfunction compared with 2 controls（5%）. Two patients with hypothyroidism, 1 with Hashimoto＇s thyroiditis and 4 with the euthyroid sick syndrome were found, whereas 2 of the controls had euthyroid sick syndrome. Compared to the volume of stand samples, the volume of the thyroid microsomal antibody and thyroid stimulating hormone increased, but the levels of triiodothyronine and free triiodothyronine decreased, which were significantly greater in comparison with the controls （P〈0.05）. Thyroid dysfunction had no obvious relation with the levels of rheumatoid factor, immunoglobulin, alexin, anti-nuclear antibody, erythrocyte sedimentation rate or C-reactive protein. Conclusion Rheumatoid arthritis complicated with hypothyroidism is not rare. Correct diagnosis should be made as early as possible.