系统性硬化症合并甲状腺功能减退患者的临床分析

目的了解系统性硬化症(SSc)合并甲状腺功能减退患者的发病率及其临床特点,指导临床早期诊断、治疗。方法回顾性分析2002年1月至2010年9月在北京协和医院住院治疗的SSc患者的临床及实验室资料,并与中国EUSTAR(EULAR Scleroderma Trial and Research group)数据库中2009年2月至2009年11月入组的未合并甲状腺功能减退的92例SSc患者的临床资料进行对比。结果 8年间在北京协和医院住院治疗的SSc患者共344例,合并甲状腺疾病20例(6.1%),其中甲状腺功能减退14例(70%)。14例患者均为女性,与未合并甲状腺功能减退患者相比,合并甲状腺功能减退的患者更易出现心包积液(50%vs.16.3%,P=0.012)及红细胞沉降率(ESR)升高(64.3%vs.27.2%,P=0.011),抗Scl-70抗体阳性者少见(21.4%vs.46.7%,P=0.018)。结论 SSc患者合并甲状腺疾病以甲状腺功能减退(含亚临床甲状腺功能减退)最为常见,当SSc患者同时存在心包积液、ESR升高及抗Scl-70抗体阴性时应警惕甲状腺受累的可能。

Clinical Analysis of Systemic Sclerosis Patients with Hypothyroidism

Objective To investigate the prevalence and clinical characteristics of systemic sclerosis （SSc） patients with hypothyroidism. Methods Medical charts of 14 consecutive SSe patients adimitted to Peking Union Medical College Hospital （PUMCH） from Jan. 2002 to Sep. 2010 were systematically reviewed. Ninety-two SSc patients without hypothyroidism from Chinese EUSTAR Database between Feb. 2009 and Nov. 2009 were selected as controls. Results There were 344 SSe patients admitted in PUMCH from Jan. 2002 to Sep. 2010. 20 patients （6. 1%） had thyroid diseases, 14 cases had hypothyroidism. All patients were female. According to univariate analysis, there were significant differences in pericardial effusion （50% vs. 16.3% , P = 0. 012） , increased ESR （64. 3% vs. 27.2% , P = 0.011 ） and anti-Scl-70 antibody positivity （21.4% vs. 46.7% , P = 0. 018） between patients with and without hypothyroidism. Conclusion Hypothyroidism （including subclinical hypothyroidism） is the most common thyroid disease in SSc patients, especially in that with pericardial effusion, increased ESR, and anti-Sel-70 antibody negative.