IgG4相关疾病患者甲状腺功能状况的分析

Analysis of thyroid function status in patients with immunoglobulin 4-related disease

目的:总结分析IgG4相关性疾病(immunoglobulin 4-related disease,IgG4-RD)患者的甲状腺功能状况,以提高临床医生对IgG4-RD患者监测甲状腺功能的重视。方法:以“IgG4相关疾病”为检索词,通过电子病例系统检索2005年7月至2020年9月于北京大学第一医院住院诊断为IgG4-RD患者的临床资料,分析IgG4-RD患者治疗前甲状腺功能的状况,及部分有随访资料患者甲状腺功能的改变。结果:共检索到IgG4-RD患者89例,其中男性69例,女性20例。有甲状腺功能检测结果的66例(74.2%)患者中,甲状腺功能异常者21例(低T3综合征12例,亚临床甲减/临床甲减8例,中枢性甲减1例)。其中5例有随访结果,随着IgG4-RD的治疗,3例在随访过程中甲状腺功能恢复正常;1例亚临床甲减的患者甲状腺功能无明显变化;1例低T3综合征的患者低T3程度改善。结论:IgG4-RD患者中发生甲状腺功能异常者并不少见,低T3综合征是其中最主要的表现。对于IgG4-RD患者的甲状腺功能异常需鉴别病因。部分患者治疗IgG4-RD疾病本身后甲状腺功能可能恢复。

Objective:To summarize and analyze the data of thyroid function of patients with immunoglobulin 4-related disease(IgG4-RD),so as to raise the clinicians’ awareness on monitoring the thyroid function of patients.Methods:The clinical data of IgG4-RD patients who were hospitalized and diagnosed in Peking University First Hospital from July 2005 to September 2020 were collected through searching the electronic medical record retrieval system by using “immunoglobulin 4-related diseases” as the key word. We analyzed the thyroid function status and the changes before and after the treatment of IgG4-RD patients and the changes of thyroid function of some patients with follow-up data.Results:A total of 89 IgG4-RD patients(69 males and 20 females)were enrolled in the current study. Among 66 patients(74.2%)with thyroid function test results,21 patients had thyroid dysfunction,including non-thyroid illness syndrome(NTIS,n=12),subclinical or overt hypothyroidism(n=8)and central hypothyroidism(n=1). Among them,5 patients had the follow-up results,3 patients got the normalization of thyroid function during the course of treatment and one patient remained subclinical hypothyroidism. And the decreased T3 level was improved in one patient with NTIS.Conclusion:Thyroid dysfunction is common in IgG4-RD patients,and NTIS is the main manifestation. The etiology of thyroid dysfunction in patients with IgG4-RD needs to be identified. The thyroid dysfunction may be restored in some patients with the treatment of IgG4-RD.