儿童系统性红斑狼疮患儿甲状腺相关抗体检测的临床意义  

Clinical significance of the prevalence of thyroid-related autoantibodies in childhood systemic lupus erythematosus

作　　者：许璞杰 王亚琳 宋福英[3] 马丽娟[2] 黄小兰[4] 苏改秀[1] 康闽[1] 侯俊[1] 赖建铭[1] Xu Yingjie;Wang Yalin;Song Fuying;Ma Lijuan;Huang Xiaolan;Su Gaixiu;Kang Min;Hou Jun;Lai Jianming(Department of Rheumatology and Immunology,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Center for Clinical Laboratory,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Department of Endocrinology,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Central Laboratory,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院风湿免疫科,北京100020 [2]首都儿科研究所附属儿童医院检验中心,北京100020 [3]首都儿科研究所附属儿童医院内分泌科,北京100020 [4]首都儿科研究所附属儿童医院中心实验室,北京100020

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第3期282-289,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金项目(81701618);首都儿科研究所临床培育项目(LCPY-2021-12)。

摘　　要：目的探讨儿童系统性红斑狼疮(cSLE)患儿甲状腺相关抗体检测对发现甲状腺损伤及自身免疫性甲状腺炎(AITD)的临床意义。方法选择2017年1月至2021年8月,在首都儿科研究所附属儿童医院风湿免疫科住院治疗的50例初发cSLE患儿为研究对象,并纳入cSLE组。同时选取在本院体检中心进行体检的50例健康儿童纳入对照组。回顾性分析2组受试儿的一般临床资料和甲状腺相关抗体阳性率,并对cSLE组患儿的临床特征、甲状腺相关抗体阳性率、甲状腺损伤情况、治疗和随访情况进行分析。采用电化学发光法检测促甲状腺素受体抗体(TRAb)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,与所有受试儿监护人签署临床研究知情同意书。结果①2组受试儿性别构成比、年龄等一般临床资料比较,差异均无统计学意义(P>0.05)。②cSLE组50例患儿中,年龄为4~15岁[(11.0±2.5)岁],均无甲状腺疾病家族史。所有患儿首诊时系统性红斑狼疮(SLE)病情活动评分(SLEDAI-2k)均>5分,仅1例以甲状腺损伤表现起病。50例cSLE患儿中TRAb、TgAb和TPOAb呈阳性分别为6例(12.0%)、18例(36.0%)、20例(40.0%)。对cSLE不同病情活动度患儿的甲状腺相关抗体阳性率比较,差异均无统计学意义(P>0.05)。③cSLE组患儿的3种甲状腺相关抗体阳性率均高于对照组,2组比较,差异均有统计学意义(P<0.05)。④cSLE组50例患儿中,13例(26.0%,13/50)诊断为AITD,包括12例(24.0%,12/50)桥本甲状腺炎(HT)和1例(1/50,2.0%)毒性弥漫性甲状腺肿(GD);2例(2/50,4.0%)诊断为甲状腺功能减退症(亚临床型);9例(9/50,18.0%)患儿虽然甲状腺相关抗体呈阳性,但是无甲状腺疾病症状,并且甲状腺功能及超声检查结果均正常;其余26例无甲状腺损伤。⑤50例患儿均使用糖皮质激素联合免疫抑制剂治疗,于治疗6~18个�Objective To investigate the clinical significance of the prevalence of thyroid-related antibodies in childhood systemic lupus erythematosus(cSLE)patients for the detection of thyroid injury and autoimmune thyroiditis(AITD).Methods Fifty children with first-onset cSLE who were hospitalized at the Department of Rheumatology and Immunology,Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2017 to August 2021 were selected into this study and included in cSLE group.Another fifty healthy children who underwent physical examination at same hospital were also selected and included in control group.The general clinical data and positive rate of thyroid-related antibodies of 2 groups were retrospectively analyzed.Moreover,the clinical characteristics,positive rate of thyroid-related antibodies,thyroid injury,treatment and follow-up of patients in cSLE group were retrospectively analyzed.Thyrotropin receptor antibody(TRAb),thyroglobulin antibody(TgAb),and thyroid peroxidase antibody(TPOAb)were detected by electrochemiluminescence method.The procedure followed in this study was in line with the requirements of the Helsinki Declaration of the World Medical Association revised in 2013.Informed consent for clinical research was obtatin from each patient's guardians.Results①There were no significant differences in general clinical data such as gender ratio and age between two groups(P>0.05).②Among 50 children in cSLE group,the age ranged from 4 to 15 years old[(11.0±2.5)years old],and all the 50 children had negatime family history of thyroid diseases.At the first visit,Systemic Lupus Erythematosus Disease Activing Index(SLEDAI-2k)of all children were higher than 5,and only one patient presented with thyroid injury.TRAb,TgAb and TPOAb were positive in 6 cases(12.0%),18 cases(36.0%)and 20 cases(40.0%)of 50 children with cSLE,respectively.There were no significant differences in the positive rates of thyroid-related antibodies among cSLE children with different disease activities(P>0.05).③The

关 键 词：红斑狼疮 系统性 甲状腺炎 自身免疫性 甲状腺疾病 甲状腺功能亢进症 甲状腺功能减退症 受体 促甲状腺素 儿童 

分 类 号：R725.9[医药卫生—儿科]