职业性三氯乙烯药疹样皮炎合并甲状腺功能亢进症3例临床分析  

Clinical analysis on three cases of occupational medicamentosa-like dermatitis due to trichloroethylene complicated with hyperthyroidism

作　　者：郎丽[1] 樊春月[1] 吴奇峰[1] 王艳艳[1] 赖明珍[1] 张莹[1] 程樱[1] 梁伟辉[1] 

机构地区：[1]广东省职业病防治院,广东省职业病防治重点实验室,广东广州510300

出　　处：《中国职业医学》2015年第6期626-628,632,共4页China Occupational Medicine

基　　金：国家科技支撑计划项目(2014BAI12B01);国家临床重点专科建设项目(2011-09)

摘　　要：目的分析职业性三氯乙烯药疹样皮炎（OMDT）合并甲状腺功能亢进症（以下简称＂甲亢＂）的临床特点。方法收集3例OMDT合并甲亢患者的临床资料进行回顾性分析。结果本组3例OMDT患者均于停用糖皮质激素2-7 d后出现发热、失眠、烦躁、心悸和多汗等高代谢症候群。体格检查和彩色多普勒超声检查均检出双侧颈部甲状腺肿大者2例,甲状腺无肿大者1例。1例患者出现突眼征。3例患者血清三碘甲状腺原氨酸和甲状腺激素水平均升高,促甲状腺激素水平均降低;1例患者血清甲状腺球蛋白抗体、甲状腺微粒体抗体和抗甲状腺过氧化物酶抗体水平均升高,1例患者血清促甲状腺激素受体抗体水平升高。临床上诊断为OMDT合并甲亢。予抗甲状腺药物治疗后,临床症状好转。结论 OMDT合并甲亢起病隐匿,易漏诊;及时予抗甲状腺药物治疗,预后较好。Objective To study the clinical features of occupational medicamentosa-like dermatitis due to trichloroethylene （OMDT） complicated with hyperthyroidism. Methods Clinical data of 3 patients who suffered from OMDT complicated with hyperthyroidism were collected for retrospective analysis. Results All 3 patients had hypermetabolism syndromes such as fever, insomnia, dysphoria, palpitation and sweating, 2-7 days after they stopped taking glucocortieoid. Doublesided thyroid enlargement in the neck were found in 2 cases by physical examination and color doppler ultrasound. There was no thyroid enlargement in the third case. One of the cases showed symptoms of exophthalmos. All 3 cases had increased levels of tfiiodothyronine and thyroxine increased and thyroid stimulating hormone reduced. The levels of thyroglobulin antibody, thyroid microsomal antibody and anti-thyroid peroxidase antibody increased in one of the cases. The level of thyrotropin receptor autoantibody increased in another case. All 3 cases were diagnosed as OMDT complicated with hyperthyroidism. After taking anti-thyroid medications in time, the clinical symptoms of these 3 cases were improved. Conclusion OMDT complicated with hyperthyroidism is more likely to be mis-diagnosed as the early clinical manifestation is not typical. Taking anti-thyroid medications in time will improve prognosis.

关 键 词：三氯乙烯 药疹样皮炎 甲状腺 甲状腺功能亢进症 临床分析 预后 

分 类 号：R135.7[医药卫生—劳动卫生]