本文選題：IgG4　切入點：Graves病　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察IgG4相關(guān)性Graves病和橋本氏甲狀腺炎的臨床特點,指導(dǎo)認識和治療IgG4相關(guān)性甲狀腺疾病。方法:隨機收集Graves病和橋本氏甲狀腺炎患者。檢測血清IgG4水平,按是否1.35g/L分為陽性組與陰性組。分析比較兩組患者的年齡、性別、病程、證型分布、甲狀腺功能、超聲、藥物治療劑量、吸煙史、自身免疫性疾病家族史等。結(jié)果:(1)114名Graves病患者中10人(8.77%)為陽性,男性占20%。兩組患者的年齡、BMI、FT3、FT4、TgAb及TPOAb水平、結(jié)節(jié)發(fā)生率、突眼率及AID家族史等均無統(tǒng)計學(xué)差異。伴高水平IgG4者,患者發(fā)病年齡相對較小(32.21±15.01y vs.33.87±13.64y,p=0.482),但無統(tǒng)計學(xué)意義。IgG4升高者Graves病病情更重,其TSH水平顯著低于非IgG4升高者(0.29±0.83uIU/ml vs.3.09±14.90uIU/ml,p=0.013),伴有明顯高于陰性組的TRAb水平(17.37± 13.61mIU/ml vs.9.13±12.04mIU/ml,p=0.017)及抗甲狀腺藥物(ATD)劑量(17.13±8.62mg vs.9.08±7.93mg,p=0.005),均有統(tǒng)計學(xué)差異。相關(guān)性分析中,IgG4水平與TRAb呈微弱正相關(guān),r=0.239,p=0.016。對77例患者進行證候分析,結(jié)果顯示無論IgG4陽性與否,患者均以心肝火旺證為主。(2)102名橋本患者,僅9人(8.82%)為陽性,均為女性。陽性組與陰性組在年齡、FT3、FT4、TSH、TgAb水平、結(jié)節(jié)發(fā)生率、AID家族史等方面無統(tǒng)計學(xué)差異。TPOAb水平顯著高于陰性組(1300 ±0U/ml vs.912.21±520.61U/ml,p=0.029)。然而,相關(guān)性分析顯示IgG4水平與TPOAb水平無相關(guān)性,r=0.001,P=0.989。陽性組甲減程度更重,LT4替代劑量顯著高于陰性組(58.93±48.80ug vs.26.36±37.62ug,p=0.049)。對68例橋本患者進行證候分析,結(jié)果顯示陽性以痰瘀互結(jié)型為主,但無人表現(xiàn)為脾腎陽虛證,陰性者以痰瘀互結(jié)證為主,其次為脾腎陽虛證。結(jié)論:IgG4陽性Graves病患者病情重于陰性者,所需用藥劑量更大,且病程中易反復(fù),纖維化更為嚴重。臨床上遇到病情易反復(fù)、易復(fù)發(fā)者或病情嚴重者,應(yīng)考慮檢測血清IgG4水平,必要時加用糖皮質(zhì)激素治療。對于TRAb水平較高者,注意檢測IgG4水平,積極控制甲功水平,甲功恢復(fù)后TRAb水平仍居高不下者考慮加用糖皮質(zhì)激素。IgG4陽性的橋本患者甲減程度更為嚴重,臨床上對于TPOAb超高的橋本患者可行血清IgG4檢測,.IgG4水平升高時可結(jié)合臨床癥狀,纖維化不嚴重、無明顯腫脹或壓迫癥狀時無需小劑量糖皮質(zhì)激素干預(yù),出現(xiàn)上述表現(xiàn)時排除激素禁忌后立即予大劑量激素治療,短暫強化后再改為小劑量維持。
[Abstract]:Objective: to observe the clinical characteristics of IgG4 associated Graves disease and Hashimoto's thyroiditis, and to guide the understanding and treatment of IgG4 associated thyroid disease. Methods: the patients with Graves's disease and Hashimoto's thyroiditis were randomly collected and the serum IgG4 levels were measured. According to whether 1.35g / L was divided into positive group and negative group, the age, sex, course of disease, distribution of syndromes, thyroid function, ultrasound, dosage of drug therapy, smoking history were analyzed and compared between the two groups. Results among the 114 patients with Graves's disease, 10 (8.77) were positive, and 20 were male. There was no significant difference in the levels of TGAb and TPOAb, the incidence of nodules, the rate of exophthalmos and the family history of AID between the two groups. There was no significant difference in the incidence of nodules, the rate of exophthalmos and the family history of AID. The age of onset was 32.21 鹵15.01y vs.33.87 鹵13.64yd 0.482g, but no significant increase of IgG4 was found in patients with Graves disease. The level of TSH was significantly lower than that of the patients without elevated IgG4 (0.29 鹵0.83u / ml vs.3.09 鹵14.90u vs.3.09 鹵14.90uIUP / ml 0.013), and the level of TRAb was 17.37 鹵13.61mIUP / ml vs.9.13 鹵12.04mIUP / ml (0.017) and the dose of antithyroid drug ATD was 17.13 鹵8.62mg vs.9.08 鹵7.93mgp0.005.There was a statistical difference between the level of IgG4 and TRAb in the correlation analysis. 77 patients were analyzed for syndromes, The results showed that no matter whether IgG4 was positive or not, 102 patients with heart-liver-fire flourishing syndrome, only 9 patients were positive, all of them were female. There was no significant difference in nodule incidence and family history. TPOAb level was significantly higher than that in negative group (1 300 鹵0 U / ml vs.912.21 鹵520.61 U / ml vs.912.21 鹵0. 029 U / ml). Correlation analysis showed that there was no correlation between IgG4 level and TPOAb level. The degree of hypothyroidism in positive group was significantly higher than that in negative group (58.93 鹵48.80 ug vs.26.36 鹵37.62 ug vs.26.36 鹵37.62 ug vs.26.36 0.049). However, none of the patients showed deficiency of spleen and kidney yang, the negative cases were mainly characterized by phlegm and blood stasis, followed by deficiency of spleen and kidney yang. Conclusion the patients with Graves disease with positive IgG4 were more serious than those with negative disease, and the dosage needed was higher, and it was easy to repeat in the course of disease. Fibrosis is more serious. In patients who are prone to relapse, relapse or severe disease, we should consider testing serum IgG4 level, and use glucocorticoid if necessary. For those with higher TRAb level, we should pay attention to detecting IgG4 level. Positive control of the level of thyroid function, after the recovery of the TRAb level is still high, considering the use of glucocorticoid. IgG4 positive patients with more severe hypothyroidism. In clinical practice, the elevated serum IgG4 level in patients with high TPOAb can be combined with clinical symptoms, fibrosis is not serious, and there is no need for low dose glucocorticoid intervention when there is no obvious swelling or compression. High dose hormone therapy was given immediately after hormone taboo was removed, and then changed to low dose maintenance after brief enhancement.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R581

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相關(guān)期刊論文 前10條

1 楊麗爽;謝瑞;許凱麗;趙娜;李靜蔚;;橋本氏甲狀腺炎中醫(yī)證候及辨證用藥分析[J];哈爾濱醫(yī)藥;2016年02期

2 張曉煒;劉f，

本文編號：1598577