重症肌无力伴甲状腺病变106例的临床分析

Clinical features of myasthenia gravis with thyroid disease with 106 patients

目的 探讨重症肌无力（MG）伴甲状腺病变的临床特点、病程及预后.方法 应用回顾性病例分析方法,收集首都医科大学附属北京同仁医院2004年1月1日至2013年12月31日门诊及住院MG患者106例,对其临床特点、甲状腺功能及抗体与病程和预后的关系等进行分析.结果 （1）106例患者甲状腺功能异常者20例（18.87％）,甲状腺球蛋白抗体（TGAb）和（或）甲状腺微粒体抗体（TMAb）升高者37例（34.91％）,甲状腺异常者46例（43.40％）.甲状腺抗体升高阳性率高于甲状腺功能阳性率,差异有统计学意义（P =0.036）.（2）眼肌型MG的促甲状腺激素（TSH）水平[（2.9 ±4.0） mIU/L）]明显高于全身型[（1.5±1.1）mIU/L],P=0.01.（3）52例眼肌型患者向全身型转化的时间,甲状腺抗体升高组比抗体正常组长,P=0.04,差异有统计学意义.而TSH是否升高、甲状腺功能是否异常、甲状腺是否异常之间的转化时间相比较差异无统计学意义.（4）在病程的第1年、2年、5年,缓解组与未缓解组的TSH水平、甲状腺抗体水平、甲状腺功能、甲状腺是否异常相比较,差异均无统计学意义（均P＞0.05）.结论 MG易合并甲状腺异常,MG更易患自身免疫性甲状腺疾病.眼肌型比全身型患者更易罹患自身免疫性甲状腺疾病.合并自身免疫性甲状腺疾病的眼肌型MG患者对激素等治疗手段反应比较敏感,短期预后相对较好.MG病情缓解率与TSH水平、甲状腺抗体水平、甲状腺功能、甲状腺是否异常等均无显著相关.

Objective To report the presentation,clinical course and prognosis of myasthenia gravis （MG） with thyroid disease.Methods Retrospective data analysis was conducted.Between 2004 and 2013,we reviewed a total of 106 patients with MG.We analyzed the clinical features,the relationship between the thyroid function,antibodies and the clinical course,prognosis.Results （1） In our study,20/106 （18.87%） patients were thyroid function-abnormal,37/106 （34.91） were thyroglobulin antibodies （TGAb） and/or thyroid microsomal antibody （TMAb）-positive,and abnormality was observed in 46 （43.40%） of the thyroid gland.Thyroid antibody positive rate was higher than abnormal thyroid function rate,and the difference was significant （P =0.036）.（2） The thyroid stimulating hormone （TSH） level （（2.9 ±4.0） mIU/L） of ocular MG was higher than the level （（1.5 ± 1.1） mIU/L） of generalized MG （P =0.01）.（3）The transformation time of 52 ocular type to generalized type was longer in higher antibody group than in normal group （P =0.04）.And there were no significant differences between the elevated TSH type and the normal TSH type,the abnormal thyroid function type and normal thyroid function type,the abnormal thyroid type and the normal thyroid type.（4） Comparing the TSH level,total antibody level,TGAb,and TMAb level between the ease group and the unease group in the course of 1 year,2 years,5 years,there were no significant differences （all P 〉 0.05）.Conclusions MG is often companied with thyroid abnormalities.MG patients are more susceptible to hashimoto thyroiditis and other autoimmune thyroid diseases.Ocular type patients are more likely to suffer from thyroid function decrease than the generalized type.MG patients with hashimoto thyroiditis and other autoimmune thyroid diseases are more sensitive to respond to therapy means like glucocorticoid therapy,and the short-term prognosis is relatively good.There are no significant correlations between the MG remission rate and TSH level,total antibody level,TGAb and TMAb level.