皮肌炎合并自身免疫性甲状腺疾病的临床分析  

Clinical Analysis of Dermatomyositis Combined with Autoimmune Thyroid Disease

作　　者：王悦至 林艳伟[2] 田云还 靳政玺[1] 华青 刘蕾 陈强[1] 黎曼 WANG Yue-zhi;LIN Yan-wei;TIAN Yun-huan;JIN Zheng-xi;HUA Qing;LIU Lei;CHEN Qiang;LI Man

机构地区：[1]苏州市立医院,南京医科大学附属苏州医院,江苏苏州215000 [2]上海交通大学医学院附属仁济医院,上海200127

出　　处：《风湿病与关节炎》2023年第10期25-30,共6页Rheumatism and Arthritis

基　　金：南京医科大学科技发展基金项目(NMUB2020255);苏州市科技计划项目(SKJY2021119)。

摘　　要：目的:探讨皮肌炎合并自身免疫性甲状腺疾病(AITD)患者的临床特点、实验室特征及预后。方法:回顾性选取2017年5月至2020年8月在上海交通大学医学院附属仁济医院首次就诊诊断为皮肌炎且具备甲状腺功能、甲状腺自身抗体(ATA)及超声检测的患者共133例,根据是否合并AITD分为AITD组27例和非AITD组106例,比较2组临床表现、实验室指标及预后的差异。结果:133例皮肌炎患者中,AITD患者27例(20.30%),甲状腺功能异常81例(60.90%),ATA阳性41例(30.83%)。AITD组甲状腺功能异常主要表现为正常甲状腺病态综合征(ESS),其次为甲状腺功能减退,其中甲状腺功能减退的比例明显高于非AITD组(25.93%vs 2.83%,P<0.01)。AITD组肌痛、声嘶、水肿、球蛋白、乳酸脱氢酶、IgG均显著高于非AITD组(P<0.05)。随访期间共有33例患者死亡,AITD组死亡率高于非AITD组(33.33%vs 22.64%),但差异无统计学意义(P>0.05);2组生存率比较,差异无统计学意义(χ^(2)=1.159,P=0.282);对甲状腺功能异常患者进一步分析发现,合并ESS的皮肌炎患者中AITD组1年存活率明显低于非AITD组(50.00%vs 73.70%,χ^(2)=4.681,P=0.030)。结论:皮肌炎患者中AITD发生率高,肌肉损伤重,在表现为ESS的皮肌炎患者中预后更差,临床应重视对皮肌炎患者甲状腺状态的评估。Objective:To explore the clinical characteristics,laboratory characteristics,and prognosis of patients with dermatomyositis combined with autoimmune thyroid disease(AITD).Methods:A total of 133 patients diagnosed with dermatomyositis for the first time at Renji Hospital affiliated with Shanghai Jiao Tong University School of Medicine from May 2017 to August 2020,who had thyroid function,antithyroid antibody,and ultrasound testing,were retrospectively selected.They were divided into an AITD group of 27 patients and a non AITD group of 106 patients based on whether they had AITD.The differences in clinical manifestations,laboratory tests,and prognosis between the two groups were compared.Results:Among 133 patients with dermatomyositis,27(20.30%)had AITD,81(60.90%)had abnormal thyroid function,and 41(30.83%)were ATA positive.The main manifestation of thyroid dysfunction in the AITD group is enthyroid sick syndrome(ESS),followed by hypothyroidism,with a significantly higher proportion of hypothyroidism compared to the non AITD group(25.93%vs 2.83%,P<0.01).The AITD group showed significantly higher levels of muscle pain,hoarseness,e dema,globulin,lactate dehydrogenase,and IgG compared to the non AITD group(P<0.05).During the followup period,a total of 33 patients died,and the mortality rate in the AITD group was higher than that in the non AITD group(33.33%vs 22.64%),but the difference was not statistically significant(P>0.05);there was no statistically significant difference in survival rates between the two groups(χ^(2)=1.159,P=0.282).Further analysis of patients with thyroid dysfunction found that the one-year survival rate of patients with dermatomyositis complicated with ESS in the AITD group was significantly lower than that in the non AITD group(50.00%vs 73.70%,χ^(2)=4.681,P=0.030).Conclusion:The incidence of AITD is high in patients with dermatomyositis,with severe muscle damage.The prognosis is worse in patients with dermatomyositis manifested as ESS,and clinical attention should be paid to the evaluation o

关 键 词：皮肌炎 自身免疫性甲状腺疾病 甲状腺功能 甲状腺自身抗体 预后 

分 类 号：R593.26[医药卫生—内科学] R581[医药卫生—临床医学]