幽门螺杆菌感染与桥本甲状腺炎的前瞻性研究  

Relationship between Helicobacter pylori infection and Hashimoto’s thyroiditis:A prospective study

作　　者：岳春艳 彭一 高春斌 张贵山 张芳 董陆玲 Chun-Yan Yue;Yi Peng;Chun-Bin Gao;Gui-Shan Zhang;Fang Zhang;Lu-Ling Dong(Department of Endocrinology,The First Hospital of Zhangjiakou,Zhangjiakou 075000,Hebei Province,China;Physical Examination Center,The First Hospital of Zhangjiakou,Zhangjiakou 075000,Hebei Province,China)

机构地区：[1]张家口市第一医院内分泌一科,河北省张家口市075000 [2]张家口市第一医院体检中心,河北省张家口市075000

出　　处：《世界华人消化杂志》2021年第2期75-80,共6页World Chinese Journal of Digestology

基　　金：张家口市重点研发计划项目,No.1921097D.

摘　　要：背景桥本甲状腺炎是最常见的自身免疫性疾病,发病率逐年增高,但其病因及发病机制尚不十分清楚.幽门螺杆菌(Helicobacter pylori,H.pylori)感染与桥本甲状腺炎的关系是当前研究热点,但桥本甲状腺炎患者是否应常规筛查并根除H.pylori尚不清楚.目的探讨H.pylori感染与桥本甲状腺炎的关系,并前瞻性研究桥本甲状腺炎患者根除H.pylori是否获益.为桥本甲状腺炎患者早期是否应积极筛查并根除H.pylori提供参考.方法随机纳入2018-01/2018-12我院甲状腺工程技术诊疗中心首次就诊的甲功正常的桥本甲状腺炎患者300例,另选取体检中心300例与之匹配的健康人群作为对照组.用化学发光法对两组进行甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)及甲状腺功能的测定.碳13尿素呼气试验检测H.pylori感染.(1)比较H.pylori感染和未感染者桥本甲状腺炎的患病率;(2)桥本甲状腺炎组,比较H.pylori阳性和阴性者TPOAb和TGAb的滴度;(3)将H.pylori阳性的桥本甲状腺炎患者随机分为治疗组和对照组,治疗组予抗H.pylori治疗,对照组不予治疗.治疗结束1 mo后复查碳13尿素呼气试验评估根除治疗是否成功.在完成治疗后6 mo、12 mo,再测定两组TPOAb和TGAb滴度并与治疗前比较.结果H.pylori阳性组桥本甲状腺炎患病率64.67%(194/300),H.pylori阴性组桥本甲状腺炎患病率35.33%(106/300),差异有统计学意义(P<0.05);桥本甲状腺炎患者中,H.pylori感染者TPOAb和TGAb显著高于H.pylori阴性者.治疗组根除H.pylori后,其TPOAb和TGAb的滴度较治疗前明显下降(P<0.05),而对照组变化不大.结论H.pylori感染者桥本甲状腺炎患病率升高.H.pylori感染可使桥本甲状腺炎患者TPOAb和TGAb滴度升高.根除H.pylori可显著降低桥本甲状腺炎患者TPOAb和TGAb滴度.桥本甲状腺炎患者建议早期常规筛查H.pylori感染并积极根除.BACKGROUND Hashimoto’s thyroiditis is the most common autoimmune disease,the incidence of which is increasing year by year,but its etiology and pathogenesis are not very clear.The relationship between Helicobacter pylori(H.pylori)infection and Hashimoto’s thyroiditis is a current research hotspot,but whether patients with Hashimoto’s thyroiditis should undergo routine screening and eradication of H.pylori remains unclear.AIM To investigate the relationship between H.pylori infection and Hashimoto’s thyroiditis,and to prospectively investigate the benefit of H.pylori eradication in Hashimoto’s thyroiditis,in order to provide a reference for the early screening and eradication of H.pylori in patients with Hashimoto’s thyroiditis.METHODS A total of 300 Hashimoto’s thyroiditis patients with normal thyroid function who first visited the Thyroid Engineering and Technical Treatment Center of our hospital from January to December 2018 were randomly included.Another 300 matched healthy people from the physical examination center were selected as a control group.Thyroid peroxidase antibody(TPOAb),thyroid globulin antibody(TGAb),and thyroid function were determined by chemiluminescence.H.pylori infection was detected by C-13 urea breath test.The prevalence of Hashimoto’s thyroiditis was compared between H.pylori infected and non-infected patients.Titers of TPOAb and TGAb between H.pylori-positive and H.pylori-negative patients in the Hashimoto’s thyroiditis group were also compared.H.pylori-positive Hashimoto’s thyroiditis patients were randomly divided into a treatment subgroup and nontreatment subgroup;the treatment subgroup received anti-H.pylori treatment,and the non-treatment subgroup did not receive anti-H.pylori treatment.The C13-urea breath test was reviewed 1 mo after the treatment to assess the success of the eradication therapy.The titers of TPOAb and TGAb in the two subgroups were measured at 6 and 12 mo after treatment and compared with those before treatment.RESULTS The prevalence of Hashim

关 键 词：幽门螺杆菌 桥本甲状腺炎 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 

分 类 号：R573[医药卫生—消化系统] R581.4[医药卫生—内科学]