系统性红斑狼疮与自身免疫性甲状腺疾病的相关性研究

目的研究系统性红斑狼疮（SLE）与自身免疫性甲状腺疾病（AITD）的关系，探讨AITD的发生与SLE病情活动度是否存在相关性。方法以济宁医学院附属医院风湿免疫科2009年7月—2013年10月住院初治的220例SLE并筛查了甲状腺功能游离甲状腺三碘原氨酸（FT3）、游离甲状腺素（巩）、TSH]及甲状腺自身抗体甲状腺球蛋白抗体（TgAb）和甲状腺过氧化物酶抗体（TPOAb）]的患者为研究对象，以正常者160名作为对照，比较SLE患者与正常者间AITD的患病率和甲状腺自身抗体阳性率；同时比较SLE合并AITD组与单纯SLE组患者的甲状腺自身抗体的阳性率，并分析两组患者与SLE疾病活动指标的相关性以抗双链脱氧核糖核酸（dsDNA）抗体滴度、补体C，、C。、总补体活性、系统性红斑狼疮疾病活动指数（SLEDAI）评分作为SLE病情活动度指标]。结果220例SLE患者，合并AITD45例（20．5％），其中甲状腺功能亢进6例（13．3％），甲状腺功能减退（包括亚临床型）26例（57．8％），桥本甲状腺炎13例（28．9％）；甲状腺自身抗体阳性74例（33．6％）；AITD患病率（20．5％）和甲状腺自身抗体阳性率（33．6％）均明显高于正常者（分别为3．13％和7．50％，均P〈0．05）。SLE合并AITD组的甲状腺自身抗体的阳性率（62．2％）明显高于单纯SLE组（21．5％，P〈0．05），两组SLE患者的抗dsDNA抗体、补体C3、C4、总补体活性、SLEDAI评分等狼疮活动指标的比较，差异均无统计学意义（P〉0．05）。结论SLE有较高的AITD的患病率及甲状腺自身抗体阳性率，SLE患者甲状腺自身抗体阳性者更易患AITD，而与SLE病情活动无关，因此，在随访中应注意监测甲状腺功能及甲状腺自身抗体。

Relationship between systemic lupus erythematosus and autoimmune thyroid disease

Objective To evaluate the incidence of autoimmune thyroid disease （AITD） in systemic lupus erythematosus （SLE） and examine the correlation between AITD and SLE activity. Methods The study group included 220 SLE patients with the screening of thyroid function （ FT3 ,FT4 ,TSH） and antithyroid autoantibodies （TgAb, TPOAb ） were hospitalized into Affiliated Hospital, Jining Medical College between July 2009 and October 2013. The control group included 160 healthy subjects. We compared the prevalence of AITD between SLE patients and normal controls and also the positive rate of anti-thyroid autoantibodies was observed. We also compared the positive rate of anti-thyroid autoantibodies between AITD in SLE and simple SLE group and also analyzed the correlation between two groups of patients and SLE activity （ evaluated by the titer of anti-dsDNA, C3 , Ca, CH50, SLEDAI score）. Results Among them, 45 patients suffered from AITD （20. 5% ）. There were hyperthyroidism （ n = 6,13.3% ） and hypothyroidism （including subclinical hypothyroidism） （n = 26,57.8% ）, Hashimoto＇s thyroiditis （n = 13,28.9% ）. And 74 SLE cases were positive for anti-thyroid autoantibodies. The prevalence of AITD and the positive rate of anti-thyroid autoantibodies in SLE patients （20. 5%, 33.6% ） were higher than that in normal controls （3.13% ,7.50% ） （P 〈 0. 05 ）. The positive rate of anti-thyroid autoantibodies of SLE with AITD patients （62.2%） was higher than that in simple SLE （21.5%）. No significant differences existed in anti-dsDNA titre, C3, C4, CH50 and SLEDAI score between two groups （ P 〉 0.05 ）. Conclusions The SLE patientshave a great prevalence of AITD and a positive rate of anti-thyroid autoantibodies. Those with anti-thyroid autoantibodies have a higher incidence of AITD and it has nothing to do with SLE activity. It is essential to monitor thyroid function and thyroid autoantibodies during the follow-ups.