皮肌炎合并甲状腺功能异常的临床分析

Clinical analysis of dermatomyositis associated with thyroid dysfunction

目的探讨合并甲状腺功能异常的皮肌炎(DM)患者临床及实验室检查特征。方法回顾性分析112例DM患者,比较甲状腺功能异常组与正常组患者临床表现、实验室检查特点及死亡率差异。结果 112例DM患者中甲状腺功能异常者达48.2%,最常见表现为正常甲状腺病态综合征(ESS)(31.3%),其次是甲状腺功能减退(简称甲减)(10.7%)和甲状腺功能亢进(简称甲亢)(6.3%)。与正常组相比,ESS组患者多见合并关节炎和间质性肺疾病(ILD),也常出现C反应蛋白(C-reactive protein,CRP)、血清铁蛋白(ferritin,Fet)升高和血红蛋白(hemoglobin,HGB)降低(P均<0.05),且死亡率明显升高(P=0.006)。甲减组患者合并消化道受累比例、出现蛋白尿比例、IgM升高比例、甲状腺过氧化物酶抗体(thyroid peroxidase antibodies,TPOAb)阳性率、甲状腺球蛋白抗体(thyroglobulin antibodies,TGAb)阳性率均显著高于正常组(P均<0.05)。甲亢组患者血浆胆固醇(cholesterol,CHO)水平明显升高(P<0.05)。DM合并自身免疫性甲状腺疾病(AITD)发生率为5.4%,最常见类型为桥本甲状腺炎(HT)(3.6%)。结论 DM患者甲状腺功能异常发生率高,以ESS最常见,并且合并ESS的DM患者死亡率更高。DM伴发AITD不少见,最常见类型为HT。

Objective To study the clinical and laboratory data of dermatomyositis （DM）complicated with thyroid dysfunction.Methods A retrospective analysis of 112 patients with DM was conducted to compare the clinical manifestations,laboratory features and mortality differences between the group with thyroid dysfunction and the group without.Results 48.2％ of DM patients had thyroid dysfunction.The most common subgroup of thyroid dysfunction was euthyroid sick syndrome （ESS） （31.3％）,followed by hypothyroidism （10.7％） and hyperthyroidism （6.3％）.DM patients with ESS were more likely to have higher incidence of interstitial lung disease （ILD） and arthritis,as well as higher levels of C-reactive protein（CRP） and ferritin （Fet）,and lower level of hemoglobin （HGB） （P ＜ O.05）,and showed a higher incidence of deaths （P =0.006）.The subgroup with hypothyroidism were prone to have gastrointestinal involvement and proteinuria,with higher levels of IgM,thyroid peroxidase antibodies（TPOAb） and thyroglobulin antibodies （TGAb）（P ＜ 0.05）.The hyperthyroidism group had a significant higer level of cholesterol（CHO） （P ＜ 0.05）.The incidence of DM associated with AITD was 5.4％.The most commonly seen AITD was Hashimoto＇s thyroiditis（HT） （3.6％）.Conclusions Thyroid dysfunction is common in DM.ESS was most frequently seen and exhibited a higher incidence of deaths.AITD associated with DM is not rare.The most commonly seen type is HT.