多发性肌炎/皮肌炎并发甲状腺相关疾病患者临床特征分析

doi:10.13481/j.1671-587x.20160532

摘要/Abstract

摘要：

目的：研究多发性肌炎/皮肌炎（PM/DM）并发甲状腺相关疾病时的特征性表现，并分析其临床意义。方法：收集本院首次确诊的77例PM/DM患者，依据患者的游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）结果分为4组，分别为甲状腺功能正常组、低T3综合征组、甲状腺功能减退组和亚临床甲状腺功能减退组，收集其临床特征、实验室及免疫学检查、预后等进行分析。结果：77例PM/DM患者中，甲状腺功能异常患者共41例，其中低T3综合征组17例，占41.46%。与甲状腺功能正常组比较，甲状腺功能减退组患者中出现吞咽困难、水肿，且蛋白尿发生的比例明显升高（P<0.05）；低T3综合征组中死亡率明显升高，更易出现水肿、胸腔积液，且常伴随C反应蛋白水平升高，白蛋白和钙离子水平降低（P<0.05）。结论：PM/DM患者并发甲状腺功能异常的发生率较高，其中以低T3综合征最为常见，并发甲状腺功能减退及低T3综合征患者出现上消化道、呼吸系统和肾脏等受累的可能性大，且并发低T3综合征的患者死亡率更高。

关键词: 多发性肌炎, 皮肌炎, 甲状腺功能, 临床特征, 预后

Abstract:

Objective: To study the characteristics and clinical appearence of polymyositis(PM) or dermatomyositis(DM) combined with thyroid diseases, and to analyze the clinical significance. Methods: Total 77 patients first diagnosed as PM or DM were selected. All the patients were divided into four groups according to their thyroid functions, which were normal thyroid function group, low T3 syndrome group, hypothyroidism group, and subclinical hypothyroidism group. Their clinical manifestations, laboratory features, immunological examination results and prognosis were collected and analyzed. Results: In all the PM/DM patients, there were 41 cases with thyroid disfunction,including 17 cases(41.46%) with low T3 syndrome(41.46%). Compared with normal thyroid function group, the patients in hypothyroidism group were more vulnerable to dysphagia and edema (P<0.05); the proportion of proteinuria was also significantly increased (P<0.05). The PM/DM patients with low T3 syndrome were more easier to have higher incidence of death, higher level of C-reactive protein and lower levels of albumin and calciumion as well as higher incidence of edema and pleural effusion (P<0.05). Conclusion: The incidence of PM/DM combined with thyroid disfunction is higher, and low T3 syndrome is most common. The PM/DM patients with hypothyroidism and low T3 syndrome are more likely to suffer the digestive system, lung and kidney injuries. The patients with low T3 syndrome have a higher death rate.

Key words: polymyositis, dermatomyositis, thyroid function, clinical characteristics, prognosis

中图分类号:

R593.26

谷三炜, 马红爽, 赵令, 姜振宇. 多发性肌炎/皮肌炎并发甲状腺相关疾病患者临床特征分析[J]. 吉林大学学报(医学版), 2016, 42(05): 999-1004.

GU Sanwei, MA Hongshuang, ZHAO Ling, JIANG Zhenyu. Analysis on clinical characteristics of PM/DM combined with thyroid disease[J]. Journal of Jilin University Medicine Edition, 2016, 42(05): 999-1004.

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