共病状态下HT自身抗体与SLE疾病活动性及免疫学指标的关系

Correlation of Thyroid Autoantibodies,System Lupus Erythematosus Immunologic Indicators and Disease Activity in SLE with HT

目的探讨桥本氏甲状腺炎(HT)与系统性红斑狼疮(SLE)在共病状态下,甲状腺相关自身抗体和功能指标与SLE疾病活动性和免疫学指标等的相关性。方法 63例SLE与HT共病患者,按SLE疾病活动指数2000(SLEDAI-2000)评分进行SLE活动度分组:基本无活动组(5例)、低度活动组(19例)、中度活动组(12例)、高度活动组(27例),收集患者临床资料,以及同期检测的血清甲状腺功能指标和自身抗体、SLE相关免疫学指标、补体(C3、C4)、C-反应蛋白(CRP)、血沉(ESR)、血常规等,进行甲状腺功能指标及自身抗体在不同SLE活动度组患者间的比较,以及与SLE相关免疫学、实验室其它指标的相关性分析。结果游离三碘甲状腺原氨酸(FT3)在不同SLE活动组间差异有统计学意义(P<0.05),FT3水平与SLE活动度评分呈负相关(P=0.007);其余指标在不同活动度组间差异无统计学意义(P>0.05)。甲状腺功能指标及自身抗体与SLE相关抗体关系分析结果显示,患者抗双链DNA抗体(dsDNA)与FT3水平呈负相关,促甲状腺素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPOAb)与抗La抗体(SSB)均呈负相关(P均<0.05)。与补体等其它指标的关系分析结果显示,抗甲状腺球蛋白抗体(TgAb)与C4呈负相关,与IgA呈正相关(P均<0.05)。FT3与C3之间,游离甲状腺素(FT4)与C4之间,TgAb与IgA之间,TPOAb与ESR、IgM、Hb、IgA之间均呈正相关(P均<0.05)。其余甲状腺相关指标与SLE免疫学指标和常见的其它指标间的关联均无统计学意义。结论 SLE与HT共病状态下,甲状腺指标与SLE的疾病活动度和免疫学等指标有一定的相关性,提示HT发病和SLE疾病整体活动性可能有关。

Objective To investigate the correlation of disease activity and thyroid indicators , immunologic markers of system lupus erythematosus （SLE） in SLE with Hashimoto＇s thyroiditis （HT）. Methods The clinical data of 63 cases of SLE with HT were collected. According to Systemic lupus erythematosus disease activity index 2000 （SLEDAI-2000）, we classified the patients into four groups, which were remission group （5 cases）, low （19 cases）, moderate （12 cases） and high （27 cases） disease activity group. Each patient received the measurement of thyroid function indicators and autoantibodies, SLE immunologic indicators, serum complement （C3, C4）, C- reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, and routine blood test. The correlation of thyroid indicators, immunologic markers and disease activity were analyzed. Results The difference of free triiodothyronine （FT3） level in the four groups was statistically significant （P〈0. 05）, and FT3 was negatively correlated with SLE disease activity （P=0. 007）. There was no significant difference in other thyroid indicators and autoantibodies between the different groups （P〉 0. 05）. Negative correlation was found between FT3 level and anti-double- stranded DNA （dsDNA）, level of anti-La antibody （SSB） and thyroid stimulating hormone （TSH） or thyroid peroxidase antibody （TPOAb）. Thyroglobulin autoantibody （TgAb） was negatively related with C4, and positive correlation between FT3 and C3, FT4 and C4, TgAb and IgA. Conclusion The pathogenesis of HT is associated with the disease activity in the patients of SLE with HT.