原发性胆汁性胆管炎患者发生桥本氏甲状腺炎的临床特征及预后分析  

Features and prognosis of Hashimoto’s thyroiditis in patients with primary biliary cholangitis

作　　者：张静怡 唐映梅[1] ZHANG Jingyi;TANG Yingmei(Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]昆明医科大学第二附属医院消化内科,昆明650000

出　　处：《临床肝胆病杂志》2022年第7期1521-1528,共8页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81660102,81360072)。

摘　　要：目的探索原发性胆汁性胆管炎(PBC)患者发生桥本氏甲状腺炎(HT)的临床特征、相关因素以及预后特点。方法回顾性选取2018年1月—2020年12月就诊于昆明医科大学第二附属医院确诊为PBC且甲状腺功能检查资料完善的患者301例。根据患者甲状腺疾病累及情况,分为HT组患者83例,非HT组患者88例。对比两组患者的一般资料、临床特征及实验室检查,分析PBC患者发生HT的相关因素及预后特征。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验,计数资料两组间比较采用χ2检验和Bonferroni校正检验;相关性分析采用Spearman相关性分析,多因素分析采用二元logistic回归分析或多元线性回归分析。结果PBC患者常合并肝外自身免疫性疾病,其中HT患病率为27.6%,PBC患者中HT组较非HT组女性患者数量(χ^(2)=9.547)、Child-Pugh评分(Z=-3.100)、IgA(Z=-1.992)、IL-6(Z=-1.969)、TgAb(Z=-9.612)、TPOAb(Z=-9.739)水平明显增加,肝硬化(χ^(2)=8.807)、乏力(χ^(2)=4.951)、纳差(χ^(2)=6.636)、腹胀(χ^(2)=7.977)发生率明显增加(P值均<0.05),HT组患者较非HT组患者TC(Z=-2.743)、TG(Z=-2.332)、LDL(Z=-2.604)、C3(t=5.063)水平明显降低(P值均<0.05)。Child-Pugh评分[比值比(OR)=1.486,95%CI:1.060~2.083,P<0.05]、TgAb(OR=1.032,95%CI:1.012~1.052,P<0.05)、TPOAb(OR=1.007,95%CI:1.002~1.012,P<0.05)水平升高是PBC患者发生HT的独立危险因素。高龄(t=9.147)、UDCA治疗不应答(t=-2.727),AST(t=2.121)、ALP(t=2.446)、总胆红素(t=10.114)、IgA(t=4.162)、IL-6(t=2.033)水平升高,总蛋白(t=-3.384)、HDL(t=-3.887)、C3(t=-2.440)、C4(t=-2.422)水平降低,合并肝性脑病(t=3.685)、腹水(t=6.744)、gp210抗体阳性(t=3.125)是Mayo风险评分升高的独立危险因素(P值均<0.05),提示预后不良。PBC患者合并HT不是Mayo风险评分升高的独立危险因素(t=-0.077,P>0.05),并不影响患者预后。结论PBC患者常合并肝外自身免疫疾病,以甲状腺疾病最为多见,尤其是�Objective To investigate the clinical features,related factors,and prognosis of Hashimoto’s thyroiditis(HT)in patients with primary biliary cholangitis(PBC).Methods A retrospective analysis was performed for the patients who were diagnosed with PBC in The Second Affiliated Hospital of Kunming Medical University from January 2018 to December 2020,among whom 301 patients underwent thyroid function tests and had complete clinical data.According to the involvement of thyroid disease,they were divided into HT group with 83 patients and non-HT group with 88 patients.The two groups were compared in terms of general data,clinical features,and laboratory examination,and the factors and prognostic features of HT in patients with PBC were analyzed.The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test and the Bonferroni correction test were used for comparison of categorical data between two group;a Spearman correlation analysis was used to investigate correlation,and a binary logistic regression analysis or multiple linear regression analysis was used for multivariate analysis.Results The patients with PBC often had extrahepatic autoimmune diseases,and the prevalence rate of HT was 27.6%.Compared with the non-HT group,the HT group had significantly higher number of female patients(χ^(2)=9.547,P<0.05),Child-Pugh score(Z=-3.100,P<0.05),and levels of IgA(Z=-1.992,P<0.05),interleukin-6(IL-6)(Z=-1.969,P<0.05),thyroglobulin antibody(TgAb)(Z=-9.612,P<0.05),and thyroid peroxidase antibody(TPOAb)(Z=-9.739,P<0.05),significantly higher incidence rates of liver cirrhosis(χ^(2)=8.807,P<0.05),weakness(χ^(2)=4.951,P<0.05),poor appetite(χ^(2)=6.636,P<0.05),and abdominal distension(χ^(2)=7.977,P<0.05),and significantly lower levels of total cholesterol(Z=-2.743,P<0.05),total triglyceride(Z=-2.332,P<0.05),low-density lipoprotein(Z=-2.604,P<0.05),and C3(t=5.063,P<0.05).Increases in Child-Pugh score(odds ratio[OR]=1.486,95%confidence interval[CI]:1

关 键 词：原发性胆汁性胆管炎 甲状腺炎 自身免疫性 危险因素 预后 

分 类 号：R575.7[医药卫生—消化系统] R581.4[医药卫生—内科学]