基于IgG4分类的桥本甲状腺炎临床意义探讨

Clinical significance of IgG4 related Hashimoto thyroiditis

目的:探讨IgG4相关性桥本甲状腺炎(HT)患者血清IgG4水平及其临床意义。方法:酶联免疫吸附法测定129例HT患者血清IgG4水平,并根据IgG4水平将患者分为IgG4组(IgG4≥135 mg/dl)和非IgG4组(IgG4<135 mg/dl);电化学发光法测定血清甲状腺激素、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(Tg Ab);甲状腺超声影像检查。结果:HT患者血清TPOAb与同时测定的IgG4水平(r=0.437 1,P=0.012 7)和IgG4/IgG比值(r=0.396 2,P=0.023 5)呈显著正相关。与非IgG4组(97例)比较,IgG4组(32例):1平均患病年龄趋年轻化(P=0.029 3);2较高的血清TPOAb(P=0.002 1)、Tg Ab(P=0.012 8)水平;3超声影像:更易形成甲状腺结节(P=0.022 6);4多因素Logistic回归分析结果提示,血清IgG4、TPOAb水平是患甲状腺结节危险因素,OR值分别为1.672(P=0.021)、2.549(P=0.014)。结论:IgG4相关性HT患者存在相应的临床特征。对于血清中IgG4水平明显升高的HT患者,应更加密切监测甲状腺功能及形态变化。

Objective：To explore the serum IgG4 level in patients with IgG4-related Hashimoto thyroiditis（IgG4 HT） ,and its clinical implications. Methods： The serum IgG4 was determined in 129 patients with HT using enzyme-linked immunosorbent assays and classified into two subgroups based on IgG4 level ： IgG4 HT group （ IgG4 I〉 135 mg/dl） and non-IgG4 HT group （ IgG4 〈 135 mg/dl）. And the levels of serum thyroid hormone and thyroid peroxidase antibodies （TPOAb）and thyroglobulin antibodies （TgAb）were measured by el immunoassay. Ultrasonic imaging of the thyroid gland were detected. Results： The TPOAb levels correlated significantly with both serum IgG4 levels（r=0. 437 1 ,P=0. 012 7）and IgG4/IgG ratios（r=0. 396 2,P=0. 023 5）in the patients with HT. Compared with that of non-IgG4 FIT group（n=97） ,IgG4 HT group（n=32） ：①The mean age was lower（P=0. 029 3） ;②Higher levels of serum TPOAb （P = 0. 002 1 ） and TgAb （ P = O. 012 8） ; ③Ultrasound imaging： the more obvious thyroid nodule （P = 0. 022 6） ; ④Logistie regression analysis showed that serum IgG4 and TPOAb were the risk factor for thyroid nodules （ OR = 1. 672, P = 0. 021 ; 2. 549,P = 0. 014）. Conclusion： IgG4 HT patients existed corresponding clinical characteristics. For the HT-patients with elevated serum IgG4,thyroid function and morphology should were more closely monitored.