IgG4相关疾病患者甲状腺功能状况的分析

Analysis of thyroid function status in patients with immunoglobulin 4-related disease

摘要:

目的： 总结分析IgG4相关性疾病（immunoglobulin 4-related disease，IgG4-RD）患者的甲状腺功能状况，以提高临床医生对IgG4-RD患者监测甲状腺功能的重视。方法： 以“IgG4相关疾病”为检索词，通过电子病例系统检索2005年7月至2020年9月于北京大学第一医院住院诊断为IgG4-RD患者的临床资料，分析IgG4-RD患者治疗前甲状腺功能的状况，及部分有随访资料患者甲状腺功能的改变。结果： 共检索到IgG4-RD患者89例，其中男性69例，女性20例。有甲状腺功能检测结果的66例（74.2%）患者中，甲状腺功能异常者21例（低T3综合征12例，亚临床甲减/临床甲减8例，中枢性甲减1例）。其中5例有随访结果，随着IgG4-RD的治疗，3例在随访过程中甲状腺功能恢复正常；1例亚临床甲减的患者甲状腺功能无明显变化；1例低T3综合征的患者低T3程度改善。结论： IgG4-RD患者中发生甲状腺功能异常者并不少见，低T3综合征是其中最主要的表现。对于IgG4-RD患者的甲状腺功能异常需鉴别病因。部分患者治疗IgG4-RD疾病本身后甲状腺功能可能恢复。

Abstract:

Objective: To summarize and analyze the data of thyroid function of patients with immunoglobulin 4-related disease (IgG4-RD) , so as to raise the clinicians' awareness on monitoring the thyroid function of patients. Methods: The clinical data of IgG4-RD patients who were hospitalized and diagnosed in Peking University First Hospital from July 2005 to September 2020 were collected through searching the electronic medical record retrieval system by using "immunoglobulin 4-related diseases" as the key word. We analyzed the thyroid function status and the changes before and after the treatment of IgG4-RD patients and the changes of thyroid function of some patients with follow-up data. Results: A total of 89 IgG4-RD patients (69 males and 20 females) were enrolled in the current study. Among 66 patients (74.2%) with thyroid function test results, 21 patients had thyroid dysfunction, including non-thyroid illness syndrome (NTIS, n=12) , subclinical or overt hypothyroidism (n=8) and central hypothyroidism (n=1) . Among them, 5 patients had the follow-up results, 3 patients got the normalization of thyroid function during the course of treatment and one patient remained subclinical hypothyroidism. And the decreased T3 level was improved in one patient with NTIS. Conclusion: Thyroid dysfunction is common in IgG4-RD patients, and NTIS is the main manifestation. The etiology of thyroid dysfunction in patients with IgG4-RD needs to be identified. The thyroid dysfunction may be restored in some patients with the treatment of IgG4-RD.