丙基硫氧嘧啶诱发的抗中性粒细胞胞质抗体阳性甲状腺功能亢进患者的临床研究  

Clinical features and outcomes of hyperthyroidism patients positive in propylthiouracil-induced antineutrophil cytoplasmic antibody

作　　者：叶华[1] 高莹[1] 郭晓蕙[1] 赵明辉[2] 

机构地区：[1]北京大学第一医院内分泌科,100034 [2]北京大学第一医院肾内科,100034

出　　处：《中华医学杂志》2005年第47期3323-3327,共5页National Medical Journal of China

摘　　要：目的研究丙基硫氧嘧啶(PTU)诱发的抗中性粒细胞胞质抗体 (ANCA) 阳性的甲状腺功能亢进症(甲亢)患者的临床和预后特点.方法对45例PTU诱发的ANCA阳性的甲亢患者进行长期随访(3～60个月,中位数27个月),观察其甲状腺功能和ANCA百分结合率的变化,对其中17例有小血管炎临床表现的患者进一步观察血管炎的病情变化.结果 (1)血管炎组17例患者中13例 (76.5%) 肾脏受累,表现为血尿、蛋白尿及不同程度的肾功能受损,7例(41.2%)肺脏受累,多表现为肺出血.核周型ANCA(p-ANCA)阳性率为100%,其中16例(94.1%)髓过氧化物酶(MPO)-ANCA抗体阳性.所有患者均停用PTU,6例改用他巴唑治疗甲亢,13例内脏受累较重的患者应用免疫抑制剂治疗6～12个月.除2例诊治较晚的患者发展至终末期肾衰竭外,其余患者临床症状均得到缓解,随访期间(8～60个月,中位数30个月)未发现小血管炎复发.(2)无血管炎临床表现组28例患者中有27例(96.4%)为p-ANCA阳性,14例(50.0%)的MPO-ANCA阳性.24例患者停用PTU,其中15例改用他巴唑;4例患者继续应用小剂量PTU.随访期间(3～36个月,中位数20个月)均未发生小血管炎临床表现.但血管炎组及无血管炎组多数患者ANCA百分结合率下降较慢.结论PTU诱发的ANCA阳性甲亢患者应及时停用PTU,必要时改用他巴唑治疗甲亢;血管炎病情严重者应用免疫抑制治疗.停用PTU后未发现小血管炎复发,但ANCA可较长时间维持阳性.Objective To analyze the clinical features and outcomes of hyperthyroidism patients positive in propyhhiouracil （PTU）-induced antineutrophil cytoplasmic antibody （ANCA）. Methods The clinical data, including the clinical manifestations, treatment, and outcomes of 45 PTU-induced ANCA positive patients with hyperthyroidism were prospectively studied. Results Seventeen of the 45 patients had clinically evident vasculitis and 28 of the 45 patients were not complicated by vasculitis. In the vasculitis group, 13 patients （76. 5% ） had renal involvement manifested by hematuria, proteinuria, and renal insufficiency. 7 of them （41.2%） had lung involvement and 6 of them had hemoptysis. Perinuclear ANCA （p-ANCA） was detected in all 17 patients and 16 of them （94.1%） were anti-myeloperoxidase antibodies （MPO-ANCA） positive. PTU was discontinued in all 17 patients and the treatment was switched over to methimazole （MMI） in 6 patients. Four patients with severe organ involvement received prednisone and immunosuppressant for 6 to 12 months. No relapse or death occurred during the follow-up period （8 to 60 months with a median of 30 months）. All the 17 patients achieved clinical remission except for two that developed end stage renal disease due to late diagnosis. 27 of the 28 patients without vasculitis （96.4%） were p-ANCA positive and 14 of them （50. 0% ） were MPO-ANCA positive. PTU treatment was discontinued in 24 patients and switched over to MMI treatment in 15 patients, and 4 patients continued to take low dose PTU. No vasculitis manifestation occurred during the follow-up period （3 to 36 months with a median of 20 months）. However, the ANCA titer declined slowly in most patients in both groups. Conclusion PTU treatment should be discontinued without delay in the PTU-induced ANCA positive patients with hyperthyroidism. Treatment can be switched over to MMI when necessary. Patients with severe organ involvement should receive prednisone and immunosuppressant. No vasculitis rela

关 键 词：丙硫氧嘧啶 抗体 抗中性粒细胞胞质 血管炎 

分 类 号：R581.1[医药卫生—内分泌]