重症肌无力患者甲状腺功能和甲状腺抗体情况的临床分析

Thyroid Function and Circulating Antithyroid Antibodies in Myasthenia Gravis

目的 了解重症肌无力 ( MG)患者甲状腺功能及甲状腺抗体的情况。方法 回顾性分析了 2 67例临床确诊 MG患者的甲状腺素水平 ,对其中 2 64例患者检测了甲状腺球蛋白抗体 ( TGAb)和甲状腺过氧化物酶抗体( TPOAb)或甲状腺微粒体抗体 ( TMAb)。结果 5 5例 ( 2 0 .6% )患者有甲状腺功能异常 ,48例 ( 1 8.2 % )至少有 1项上述抗体阳性。甲状腺功能异常的 MG患者中 , 、 、 型抗体阳性者较多 ( P <0 .0 1 )。甲状腺抗体阳性者较抗体阴性者 MG发病晚 ( P <0 .0 5 ) ;甲状腺抗体阴性 MG患者有甲状腺功能障碍者 MG发病早于功能正常组 ( P <0 .0 5 )。甲状腺功能异常、抗体阳性的 MG患者病程较抗体阴性者长 ( P <0 .0 5 ) ;甲状腺抗体阳性者伴发胸腺增生或胸腺瘤的几率明显增高 ( P <0 .0 5 )。结论 MG合并甲状腺功能异常并不少见 ,甲状腺抗体阳性、功能异常的 MG患者病程长 ,伴发胸腺增生或胸腺瘤的几率高 ,临床应予以重视。

Objective To explore the clinical characteristics of myasthenia gravis(MG) with alteration of thyroid function and/or with circulating antithyroid antibodies. Methods The clinical data of 267 patients with MG were reviewed retrospectively. Thyroid function was evaluated by FT 3, FT 4 and TSH. The presence of circulating antithyroglobulin antibodies (TGAb), antiperoxidase antibody (TPOAb) and antimicrosomal antibodies (TMAb) were measured in 264 patients. Results There were 79.4% euthyroidism. The abnormality included thyrotoxicosis (5.2%), preclinical hyperthyroidism (0.4%), preclinical essential hypothyroidism (2.6%), secondary hypothyroidism (0.7%) and uncertainty (11.6%). In our study, 44/264(16.7%) myasthenic patients were TGAb-positive, 15/92 (16.3%) were TPOAb-positive and 20/172 (11.6%) were TMAb- positive. Antibody-positive MG-patients were more popular in generalized type ( P <0.01) of the abnormal thyroid function group. Comparing with the antibody-positive MG-patients, antibody-negative inclined to have earlier onset age of MG. Furthermore, as to the MG-patients with abnormal thyroid function parameters, they were more susceptible to thymic hyperplasia and thymoma ( P <0.05), and the courses of this disease were much more prolonged ( P <0.05). Conclusions MG coexistence with thyrotoxicosis and other thyroid diseases are not infrequent. Early diagnosis and timely treatment are critical to a good prognosis.