系统性红斑狼疮患者伴发甲状腺疾病的临床分析

Clinical analysis of thyroid diseases in patients with systemic lupus erythematosus

目的研究系统性红斑狼疮患者并发甲状腺疾病的患病情况及其并发桥本甲状腺炎、亚临床甲状腺功能减退症的相关危险因素,以期为临床防治提供依据。方法选择2017年5月~2019年5月于湖北省中医院住院治疗的66例系统性红斑狼疮患者,其中合并桥本甲状腺炎患者15例为观察A组,未合并桥本甲状腺炎患者26例为对照A组;合并亚临床甲状腺功能减退症患者9例为观察B组,未合并亚临床甲状腺功能减退症患者52例为对照B组。观察患者甲状腺疾病发生率,并分析患者一般情况(性别、年龄、病程)、血液分析、红细胞沉降率(ESR)、C反应蛋白(CRP)、免疫功能、甲状腺功能、血脂[三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)]、血尿酸(UA)、ENA抗体谱、抗核抗体(ANA)、白蛋白(ALB)水平和临床表现。结果除年龄外,观察A组与对照A组患者其他指标比较,差异无统计学意义(P>0.05)。年龄是系统性红斑狼疮并发桥本甲状腺炎独立的危险因素[OR(95%CI)=1.064(1.004,1.128),P<0.05]。除免疫球蛋白M(IgM)和抗Ds-DNA抗体阳性(Ds-DNA)外,观察B组与对照B组患者其他指标比较,差异无统计学意义(P>0.05)。抗Ds-DNA抗体是系统性红斑狼疮并发亚临床甲状腺功能减退症独立的危险因素[OR(95%CI)=10.573(1.673,66.810),P<0.05]。结论系统性红斑狼疮并发甲状腺疾病的发生率高,桥本甲状腺炎和亚临床甲状腺功能减退症是其较常并发的甲状腺疾病,年龄是系统性红斑狼疮并发桥本甲状腺炎独立的危险因素,抗Ds-DNA抗体是系统性红斑狼疮并发亚临床甲状腺功能减退症独立的危险因素。

Objective To study the prevalence of thyroid disease in patients with systemic lupus erythematosus and associated risk factors of Hashimoto′s thyroiditis and subclinical hypothyroidism in systemic lupus erythematosus,so as to provide evidence for clinical prevention and treatment.Methods Sixty-six patients with systemic lupus erythematosus hospitalized in Hubei Hospital of Traditional Chinese Medicine from May 2017 to May 2019 were selected as the study subjects.Among them,a total of 15 cases with Hashimoto′s thyroiditis were observation group A,26 cases without Hashimoto′s thyroiditis were control group A;a total of 9 cases with subclinical hypothyroidism were observation group B,a total of 52 cases without subclinical hypothyroidism were control group B.The incidence of thyroid disease in systemic lupus erythematosus was observed,and the general condition(gender,age,course of disease),blood analysis,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),immune function,thyroid function,blood lipid(triacylglycerol[TG],high density lipoprotein cholesterol[HDL-C]),uric acid(UA),ENA antibody spectrum,anti-nuclear antibodies(ANA),albumin level(ALB)and clinical manifestations were statistically processed.Results Except for age,there was no statistically significant difference between group A and control group A patients(P>0.05).Age was an independent risk factor for systemic lupus erythematosus complicated with Hashimoto′s thyroiditis(OR[95%CI]=1.064[1.004,1.128],P<0.05).Except for immunoglobulin M(IgM)and anti-Ds-DNA antibody positive(Ds-DNA),there was no statistically significant difference between other indicators of group B and control group B(P>0.05).Anti-Ds-DNA antibody was an independent risk factor for systemic lupus erythematosus complicated with subclinical hypothyroidism(OR[95%CI]=10.573[1.673,66.810],P<0.05).Conclusion The incidence of systemic lupus erythematosus complicated with thyroid disease is high.Hashimoto′s thyroiditis and subclinical hypothyroidism are relatively common thyroid diseases.Age is an independent risk factor for systemic lupus erythematosus complicated with Hashimoto′s thyroiditis.Anti-Ds-DNA antibody is an independent risk factor for systemic lupus erythematosus complicated with subclinical hypothyroidism.