抗甲状腺药物诱发ANCA相关血管炎研究  

Study of ANCA Induced by Antithyroid-drugs in Patients with Graves' disease

作　　者：周波 池莲祥[2,3] 聂本遂[2,3] 

机构地区：[1]广东省湛江市中心人民医院内分泌科,524000 [2]广东省深圳市第八人民医院 [3]南方医科大学附属深圳宝安医院内分泌科

出　　处：《齐齐哈尔医学院学报》2012年第7期845-848,共4页Journal of Qiqihar Medical University

基　　金：深圳市科技局(JH200505300507A);深圳宝安区科技局(2005162)科技基金项目资助

摘　　要：目的了解抗甲状腺药物在治疗甲状腺功能亢进症(甲亢)过程中是否诱发抗中性粒细胞胞浆抗体(ANCA)相关血管炎。方法对60例初诊Graves病甲亢患者进行研究,分为两组,每组各30例,分别予以他巴唑(MMI)及丙基硫氧嘧啶(PTU)治疗。检测研究对象初诊与药物治疗后第24个月的血清ANCA水平,以及TT4、TT3、FT4、FT3、TSH、TPOAb、TGAb、小便常规、血常规、肝功能、肾功能等临床指标。结果治疗组各25例完成2年追踪观察,失访率16.7%。两组在性别、年龄分布上无差别(性别:25%vs 40%,χ2=3.57,P=0.61;年龄(31.6±9.3)岁vs(33.8±10.8)岁,t=0.79,P=0.42。研究对象初诊时均无血管炎。药物治疗2年过程中,PTU组6/25例(24%)和MMI组5/25例(20%)患者发生小血管炎(24%vs 20%,χ2=0.17,P=0.70),其中PTU组4/6(66.7%)例与MMI组0/5(0%)例ANCA阳性(66.7%vs 0%,χ2=2.75,P=0.06)。结论在内科药物治疗过程中,丙基硫氧嘧啶(PTU)可以诱发ANCA及ANCA相关血管炎,而他巴唑(MMI)可能诱发与ANCA无关血管炎。Objective To evaluate the relationship between small-vessel vasculitis related with antineutrophil cytoplasmic autoantibodies（ANCA） and antithyroid medication in the patients with hyperthyroidism.Methods Of 60 patients with newly diagnosed Graves＇ disease,30 of them received PTU medication as PTU subgroup and the other 30 received MMI as MMI subgroup.Serum ANCA in the 24th month after medication was determined by indirect immunofluorescence（IIF）.TT4,TT3,FT4,FT3,TSH,TPOAb,AGAb,blood test,urinalysis,liver and renal functions were checked in all subjects as well.Results Of 25 patients observed in each study group after 2 years,5 patients were lost,and the lost rate was 16.7%.There were no significant differences between the 2 groups inage and gender（gender： 25% vs.40%,χ2=3.57,P=0.61;age：31.6±9.3 vs.33.8±10.8,t=0.79,P=0.42）.All the patients had no vasculitis before treatment.After receiving antithyroid-drugs for 2 years,6 of 25 patients（24%） receiving PTU therapy and 5 of 25 patients（20%） receiving MMI therapy appeared symptoms of small-vessel vasculitis,of which the prevalence of vasculitis had no significant difference（24% vs.20%,χ2=0.17,P=0.70）.4 of 6（66.7%） patients with small-vessel vasculitis in PTU group and zero in MMI group were ANCA positive.Conclusions PTU can induce ANCA and ANCA-associated vasculitis in patients with hyperthyroidism,while MMI may induce vasculitis not associated with ANCA.

关 键 词：GRAVES病 抗中性粒细胞胞浆抗体 抗甲状腺药物 

分 类 号：R692.3[医药卫生—泌尿科学]