系统性红斑狼疮与自身免疫性甲状腺疾病相关性分析

Clinical analysis of systemic lupus erythematosus complicated with autoimmune thyroid disease

目的系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种常见自身免疫相关性疾病,自身免疫甲状腺疾病(autoimmune thyroid disease,AITD)是由自身免疫紊乱导致的甲状腺疾病。本研究探讨AITD在SLE中的发病情况,探讨SLE合并AITD的临床和血清学特点,分析其高危因素。方法选取2015-09-01-2017-09-01焦作市第二人民医院收治的112例SLE患者作为研究对象,根据是否合并甲状腺球蛋白抗体(thyroglobulin antibody,TG-Ab)或甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPO-Ab)阳性,分为SLE未合并AITD组74例,即未合并两种抗体阳性;SLE合并AITD组38例,即合并TG-Ab或TPO-Ab阳性。比较两组临床表现和抗体水平,并进行血清生化及游离三碘甲腺原氨酸(free triiodothyronine,FT3)、血清游离甲状腺素(free thyroxine,FT4)、血清促甲状腺素(thyroid stimulating hormone,TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPO-Ab)、甲状腺球蛋白抗体(thyroglobulin antibody,TG-Ab)的检测。采用Logistic回归分析SLE合并AITD的危险因素。结果临床表现上,SLE未合并AITD组的光敏感发生率为12.8%,低于SLE合并AITD组的13.6%,χ~2=3.926,P=0.048;抗体结果显示,SLE未合并AITD组的SSB抗体阳性率为55.4%,低于SLE合并AITD组的76.3%,χ~2=4.684,P=0.030;Logistic回归分析结果显示,SSB(OR=1.48,95%CI为1.22~1.72,P=0.013)是发生SLE合并AITD的独立危险因素。结论 SLE与AITD关系密切,SSB是发生SLE合并AITD的高危因素,可指导临床对SSB阳性患者进一步筛查AITD相关指标,及早进行AITD诊断和甲状腺功能评估。

OBJECTIVE Systemic lupus erythematosus（SLE）is a common autoimmune disease,and autoimmune thyroid disease（AITD）is a thyroid disease caused by autoimmune disorders.This study aims to investigate the incidence of AITD in SLE,explore the clinical and serological characteristics of SLE combined with AITD,and analyze its high risk factors.METHODS A total of 112 patients with SLE who were treated in Jiaozuo Second People＇s Hospital from September 1 st,2015 to September 1 st,2017 were selected according to whether they combined with Thyroglobulin antibody（TG-Ab）or Thyroid peroxidase antibody（TPO-Ab）positive,divided into SLE not combined with AITD group（n=74）,SLE combined with AITD group（n=38）.The clinical manifestations and antibody levels of the two groups were compared,and serum biochemical and free three iodide adenosine（FT3）,free thyroxine（FT4）,thyroid stimulating hormone（TSH）,thyroid peroxidase antibody（TPO-Ab）and thyroglobulin antibody（TG-Ab）were detected.Logistic regression analysis was used to find the risk factors for SLE combined with AITD.RESULTS In clinical manifestations,the incidence of light sensitivity in SLE patients without AITD was 12.8%,lower than that in patients with SLE and AITD（13.6%）,χ~2=3.926,P=0.048.Antibody results showed that the positive rate of SLE not combined with AITD group was55.4%,lower than that of SLE combined with AITD group（76.3%）,χ~2=4.684,P=0.030.Logistic regression analysis showed that SSB（OR=1.48,95%CI：1.22-1.72,P=0.013）was an independent risk factor for SLE combined with AITD.CONCLUSIONS SLE and AITD are closely related.SSB is risk factor for SLE combined with AITD.W SLE is closely related to AITD.SSB is a high risk factor for the occurrence of SLE combined with AITD.It can guide the further screening of AITD related indicators for the SLE patients with SSB positive,the early AITD diagnosis and thyroid function assessment.