白癜风与自身免疫性甲状腺疾病

白癜风的病因及发病机制尚未完全阐明,目前多认为自身免疫在白癜风的发病中占重要地位.近年来发现,白癜风常伴发其他自身免疫性疾病,如自身免疫性甲状腺疾病、胰岛素依赖型糖尿病、恶性贫血、Addison病、系统性红斑狼疮、炎性肠病等,其中以自身免疫性甲状腺疾病最多见.从易感基因、甲状腺自身抗体、甲状腺激素水平、CD4+CD25+调节性T细胞、氧化应激等方面就白癜风伴发自身免疫性甲状腺疾病的研究进展进行概述,进一步探讨白癜风与自身免疫性疾病的相关性.     

拟似自身免疫及风湿病类型的白癜风

甲状腺病、糖尿病、恶性贫血及伴随Addison病的自身免疫肾上腺炎患者有异常高的白癜风发生率.白癜风患者血清内常有一种同甲状腺及胃的器官特异性自身抗原反应的抗体,少数患者血清内有一种同表皮黑素细胞反应的抗体.这些发现及损害的组织学变化提示,至少某些患者是属于器官特异性自身免疫疾病.作为此类疾病研究,作者发现某些患者皮损解剖分布同典型的自身免疫及风湿病的内脏损害解剖分布类似.     

白癜风与甲状腺自身抗体的相关性研究进展

白癜风病因复杂,其中免疫因素是白癜风发生发展的关键。白癜风患者常伴发一种或多种自身免疫性疾病,其中最重要的是自身免疫性甲状腺疾病。在临床诊疗中我们发现许多白癜风患者,尤其是非节段型白癜风患者,其甲状腺自身抗体(主要是TPOAb和Tg Ab)水平常有异常。本文根据现有文献,分析白癜风的发病以及白癜风与甲状腺相关抗体的相关性,以为白癜风病因研究提供新的理论依据。     

白癜风与自身免疫性疾病相关性研究进展

白癜风病因复杂,其中免疫因素是白癜风发生发展的关键因素,30%的白癜风患者伴发一种或多种自身免疫性疾病,包括自身免疫性甲状腺疾病、1型糖尿病、腹腔病、自身免疫性胃炎、恶性贫血、艾迪生病等,并表明白癜风与自身免疫性疾病有共同的发病基础,但其机制不清。故根据现有文献,分析白癜风的发病以及白癜风与自身免疫性疾病的相关性,为白癜风病因研究提供新的理论依据。     

白癜风与甲状腺疾病:一项基于韩国人群的研究

<正>白癜风是一种常见的获得性色素脱失性疾病,以皮肤黑素细胞功能丧失为特点,全球发病率为0.5%~2%。白癜风病因尚不明确,自身免疫被认为是其发病的核心机制。白癜风患者可伴发多种自身免疫性疾病如甲状腺疾病、斑秃、Ⅰ型糖尿病、恶性贫血、类风湿关节炎。其中,自身免疫性甲状腺疾病在白癜风患者中较为常见。有研究报道认为在白癜风患者中甲状腺疾病的发病率为     

白癜风相关的黑素细胞抗原

自身免疫在白癜风发病机理中占重要地位。患者血清中存在抗黑素细胞自身抗体 ,通过与黑素细胞抗原结合 ,引发一系列免疫反应 ,破坏黑素细胞。现已明确的白癜风相关黑素细胞抗原分为胞浆抗原和胞膜抗原两大类 ,这些抗原通过多种途径共同作用 ,介导了白癜风的免疫病理过程。     

白癜风相关的黑色素细胞抗原

自身免疫在白癜风发病机理中占重要地位。患者血清中存在抗黑素细胞自身抗体，通过与黑素细胞抗原结合，引发一系列免疫反应，破坏黑素细胞。现已明确的白癜风相关黑素细胞抗原分为胞浆抗原和胞膜抗原两大类，这些抗原通过多种途径共同作用，介导了白癜风的免疫病理过程。     

慢性自身免疫性荨麻疹研究进展

慢性自身免疫性荨麻疹发病以自身免疫反应为基础.这类有自身抗体参与的慢性自身免疫性荨麻疹在预后和治疗上均有其特殊性,常规的抗组胺药物治疗很难奏效.研究发现,慢性自身免疫性荨麻疹的发病原因与抗IgE及其受体的自身抗体、自身免疫性甲状腺疾病以及幽门螺杆菌感染、遗传因素、精神因素等诸多因素有关.慢性自身免疫性荨麻疹患者体内B淋巴细胞刺激因子水平增高,刺激产生抗IgE的高亲和力受体抗体和抗IgE抗体,与肥大细胞结合后诱发自身免疫性荨麻疹.     

白癜风发病与自身免疫性甲状腺病的相关性探讨

目的探讨白癜风与自身免疫性甲状腺病(AITD)的发生是否存在相关性。方法用化学发光分析法测定38例白癜风患者和35名正常人群的甲状腺功能(包括抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体),比较白癜风患者和正常对照组间甲状腺自身抗体阳性率,同时比较甲状腺自身抗体阳性的白癜风患者与甲状腺自身抗体阴性的白癜风患者间AITD患病率。结果白癜风患者T3和T4与正常对照组比较差异无显著性(P>0.05),而白癜风患者FT3和FT4与正常对照组比较差异均有显著性(P<0.05)。白癜风患者血清TSH与正常对照组比较差异有显著性(P<0.01)。白癜风患者甲状腺自身抗体阳性率与正常对照组比较均有增高趋势(P<0.05)。甲状腺自身抗体阳性的白癜风患者AITD患病率(41.18%)与甲状腺自身抗体阴性的白癜风患者(9.52%)间比较明显增高(P<0.05)。结论白癜风的发病与甲状腺功能的改变和自身免疫有着密切的联系。     

伴甲状腺疾病的白癜风64例移植疗效回顾性分析

目的回顾性分析64例伴甲状腺疾病的白癜风患者移植疗效与甲状腺疾病类型的关系。方法将64例曾行自体黑素细胞培养移植伴甲状腺疾病的白癜风患者分为两组,观察组A为伴甲亢或甲减的白癜风患者;观察组B为伴甲状腺自身抗体(抗甲状腺球蛋白抗体或抗甲状腺过氧化物酶抗体)水平升高的白癜风患者;并随机选取同时期行自体黑素细胞培养移植的单纯白癜风患者64例为对照组。结果观察组A的移植疗效最差,只有2例患者的移植复色率超过65%,与对照组的移植疗效差异有统计学意义(P0.05);而观察组B的移植疗效与对照组之间差异无统计学意义(P0.05)。结论伴甲亢或甲减的白癜风患者移植疗效较单纯白癜风患者差。自体黑素细胞培养移植方法适用于伴甲状腺自身抗体水平升高的白癜风患者。     

Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms

Background Vitiligo/nonsegmental vitiligo (NSV) is often associated with thyroid dysimmunity although very few reports have studied this association using multivariate logistic regression. Objective To identify weighted factors associated with the presence of autoimmune thyroid disease (AITD) in a large cohort of patients with vitiligo/NSV. Methods This was a prospective observational study in 626 patients with a confirmed diagnosis of vitiligo/NSV attending the vitiligo clinic of the University Hospital Department of Dermatology, Bordeaux, France, from 1 January 2006 to 1 May 2012. The Vitiligo European Task Force (VETF) questionnaire was completed for each consecutive patient. AITD was defined as the presence of significant levels of serum antithyroperoxidase antibodies or evidence of autoimmune thyroiditis. Univariate and multivariate logistic regression procedures were conducted to identify factors associated with AITD in this cohort of patients with vitiligo/NSV. Results A total of 626 patients with vitiligo/NSV were included, of whom 131 had AITD (AITD‐vitiligo). Stress as an onset factor, familial history of AITD, body surface involvement and duration of the disease were positively associated with AITD‐vitiligo using univariate analysis, whereas female sex, age at onset of vitiligo, personal history of autoimmune disease and localization on the trunk were found to be independently associated with AITD‐vitiligo. Conclusion Vitiligo associated with AITD has clinical features distinct from vitiligo without AITD. In particular, female patients, and patients with longer duration of disease and greater body surface involvement are more likely to present with AITD and should thus be monitored for thyroid function and antithyroid antibodies on a regular basis.     

白癜风并发自身免疫性甲状腺疾病的危险因素分析及列线图预测模型的建立

目的：分析白癜风并发自身免疫性甲状腺疾病的危险因素并建立列线图预测模型。方法：收集2017年2月至2019年1月我院276例白癜风患者的临床资料，使用Logistic回归分析白癜风并发自身免疫性甲状腺疾病的独立危险因素。采用R（R 3.5.3）软件包，rms程序包，建立列线图预测模型。同时应用caret程序包进行Bootstrap法重复抽样1000次做内部验证，采用rms程序包计算一致性指数（C-index）。采用ROCR及rms程序包制作ROC曲线。结果：本研究白癜风并发自身免疫性甲状腺疾病的发生率为17.75%，高血糖、白癜风病程、白癜风类型、负性情绪、吸烟、自身免疫性甲状腺病家族史及其他自身免疫性疾病家族史为白癜风并发自身免疫性甲状腺疾病的独立危险因素（均P<0.05）。基于筛选的独立危险因素，建立预测列线图模型结果显示，实际发生率与预测发生率基本一致（χ2=3.854，P=0.724），C-index指数高达0.857（95% CI：0.829~0.885）。结论：白癜风患者应尽可能筛查自身免疫性甲状腺疾病，特别是在有危险因素的白癜风患者中。     

Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo

Background Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended. Objective To investigate the prevalence of thyroid dysfunction and thyroid peroxidase‐specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified. Methods A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti‐TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening. Results Forty‐three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results < 3 months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease. Conclusion The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti‐TPO antibodies is advisable in these high‐risk subpopulations.     

The co-occurrence of segmental vitiligo and linear morphea in a pediatric patient and a review of the literature

Linear morphea and segmental vitiligo are both autoimmune diseases that are observed in the pediatric population, with rare reports of their co-existence. We describe a case of linear morphea and segmental vitiligo with an overlapping distribution in a pediatric patient and review the literature. Including our own case, we summarize 10 cases of co-occurring segmental vitiligo and morphea in pediatric patients; most of these lesions follow a blaschkolinear distribution, and none of the patients had autoimmune thyroid disease. Although uncommon, the coexistence of segmental vitiligo and linear morphea within lines of Blaschko can occur, and this case suggests that linear morphea and segmental vitiligo may be disorders related to genetic mosaicism.     

An approach to the correlation between vitiligo and autoimmune thyroiditis in Chinese children

Background. Vitiligo is a common skin depigmenting disease, which is thought to have, at least partly, an autoimmune aetiology. Aim. To explore the correlation between paediatric vitiligo and other associated diseases, with an emphasis on autoimmune thyroiditis (AT). Methods. In total, 363 paediatric patients (198 boys, 165 girls) with vitiligo and 93 healthy children (55 boys, 38 girls) were screened for autoimmune thyroiditis. The two groups were matched for age and gender. Children with vitiligo were split into two groups according to type (segmental and nonsegmental vitiligo). Demographic data, clinical features and examinations were recorded using questionnaires. Thyroid function tests including free triiodothyronine, free thyroxine and thyroid‐stimulating hormone were performed. Anti‐thyroid peroxidase antibody) and anti‐thyroglobulin antibody levels were assessed as well. Other associated diseases were also monitored in this study. Results. Of the 363 patients, 43 (11.8%) had abnormal levels of studied thyroid parameters, compared with 4 of the 93 controls (4.3%); the difference was significant (P = 0.04). The alterations of thyroid parameters and the incidence of AT in patients with nonsegmental vitiligo were both significantly different (P < 0.05, P = 0.04) relative to the segmental vitiligo group. Of the 363 patients, 67 (18.5%) had other associated diseases. There were no differences in the rates of other associated diseases between patients with segmental vitiligo and those with nonsegmental vitiligo (P > 0.05). Conclusions. A significant incidence of thyroid dysfunction was found in paediatric patients with nonsegmental vitiligo. As vitiligo usually appears before the development of the thyroid disease, it may be advantageous to screen thyroid functions and antibody levels in all paediatric patients with vitiligo, especially those with nonsegmental vitiligo.     

白癜风并发自身免疫性甲状腺疾病的研究现状

白癜风常并发其他自身免疫性疾病,如自身免疫性甲状腺疾病(autoimmunne thyroid disease,AITD)、类风湿关节炎、1型糖尿病、恶性贫血、系统性红斑狼疮(systemic lupus erthematosus,SLE)、艾迪生病、斑秃等,其中以AITD最多见,包括Graves病、慢性淋巴细胞性甲状腺炎(桥本病)、亚急性甲状腺炎、甲状腺相关性眼病等,但有关白癜风并发AITD确切机制研究甚少。鉴于白癜风是一种多因素、多基因遗传性疾病,发病机制复杂,与遗传和各种非遗传因素相关,多数认为是由基因、环境和免疫系统的相互作用,导致共同的终末通路,即氧化应激-自身免疫介导的黑素细胞缺失,特别是非节段型白癜风(non-segmental vitiligo,NSV)。该文从白癜风的基因、自身免疫和氧化应激3个关联机制上综述、阐述其与AITD的关系。     

Relevance of autoimmune thyroiditis in children and adolescents with vitiligo

Background Vitiligo is the most common pigmentation‐related disorder worldwide. An autoimmune etiology is widely considered, and genetic factors may play an important role in its pathogenesis. The purpose of this study was to assess the incidence of thyroid dysfunctions and autoimmune thyroiditis in children with vitiligo and to identify related factors. Methods Fifty children with vitiligo and 50 control children were enrolled. Data on age, onset, duration, disease activity, presence of thyroid disorder, other autoimmune diseases, halo nevi, poliosis, and mucosal vitiligo were determined. Serum free triiodothyronine, free thyroxine, total T3, total T4, thyroid‐stimulating hormone, and antibodies to thyroperoxidase and thyroglobulin were measured. Thyroid gland efficiency was evaluated. Results The mean age at onset of vitiligo was 7.26 ± 4.43 years. The duration of vitiligo was 2.26 ± 2.95 years. Vulgaris‐type vitiligo was the most common form in our patients (56%), and 42% reported at least one family member with thyroid disorder, autoimmune disease, or both. Overt hypothyroidism or hyperthyroidism were not detected. We found a significant association between autoimmune thyroiditis and both sex and disease duration (P = 0.046 and P = 0.07, respectively), but no association between autoimmune thyroiditis and age, age at onset of vitiligo, halo nevi, poliosis, mucosal involvement, disease activity, or family history of vitiligo, autoimmunity, or thyroid disorders. Conclusions Children with vitiligo show an increased incidence of autoimmune thyroiditis. Children with vitiligo, especially girls and subjects with generalized/vulgaris‐type vitiligo, should be screened annually for thyroid function and antithyroid antibodies to assist in the early diagnosis and therapy of autoimmune thyroiditis.     

Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo

BACKGROUND: Studies that clearly define the possible association of childhood vitiligo with autoimmune and/or endocrine diseases are lacking. OBJECTIVE: To examine the presence of autoimmune disorders, in particular of thyroid disease, in paediatric patients with vitiligo and investigate the utility of such screening in these patients. METHODS: One hundred and twenty-one paediatric patients (40 males, 81 females) with vitiligo were grouped in segmental and non-segmental vitiligo. All patients were screened for thyroid disease. RESULTS: 13 out of 121 patients had different degrees of thyroid parameter alterations. These patients were all affected by the non-segmental type while none of those with the segmental form presented thyroid alterations. CONCLUSION: In paediatric patients with non-segmental vitiligo, a significant incidence of thyroid dysfunction was found. Since vitiligo usually appears before the development of the thyroid disease, it may be useful to screen thyroid autoantibodies in all paediatric patients with non-segmental vitiligo who present symptoms related to thyroid disease.