本文選題：系統(tǒng)性紅斑狼瘡 + 橋本氏甲狀腺炎��； 參考：《昆明醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的 研究橋本氏甲狀腺炎(Hashimoto's Thyroiditis HT)在系統(tǒng)性紅斑狼瘡(systemic lupus erythematosus SLE)的發(fā)病率,探討兩種疾病伴發(fā)時(shí)的臨床和實(shí)驗(yàn)室的特點(diǎn),指導(dǎo)臨床上SLE伴發(fā)HT的診斷與治療。方法回顧性表格記錄、電話回訪方法,研究昆明醫(yī)科大學(xué)第二、一附屬醫(yī)院1029例SLE患者,按試驗(yàn)設(shè)計(jì)分為3組,A組：80例SLE合并甲狀腺球蛋白抗體(Thyroglobulin Antibodies, TgAb),甲狀腺過氧化物酶抗體(Thyroid Peroxidase Antibodies, TPOAb)異常但未達(dá)到橋本氏甲狀腺炎的診斷標(biāo)準(zhǔn)(后續(xù)的住院資料或電話回訪,這80例SLE患者的TgAb、TPOAb通過治療半年后轉(zhuǎn)陰性)；B組：29例SLE合并HT(后續(xù)的住院資料或電話回訪,這29例SLE患者的TgAb、 TPOAb通過治療半年后仍陽性且甲狀腺B超改變)；C組：從920例SLE且TgAb、 TPOAb正常的患者中按同時(shí)住院時(shí)間、性別1：1篩查出109例SLE患者為對(duì)照組,抗核抗體譜、泌尿系統(tǒng)、神經(jīng)系統(tǒng)、血液系統(tǒng)、肝、腎功能、疾病活動(dòng)評(píng)分的指標(biāo)特點(diǎn)。計(jì)數(shù)資料用χ2檢驗(yàn),正態(tài)分布的計(jì)量資料用方差分析,偏態(tài)分布的計(jì)量資料用秩和檢驗(yàn),篩選出有統(tǒng)計(jì)學(xué)意義的單因素,然后使用多因素二分類Logistic回歸分析發(fā)現(xiàn)SLE合并HT的獨(dú)立危險(xiǎn)因素。結(jié)果1029例SLE患者中,29例合并橋本甲狀腺炎,發(fā)病率為2.8%。三組的線粒體M2陽性率分別為(18.7%、24.1%、6.08%,P0.05),口腔潰瘍發(fā)生率(8.75%、27.5%、8.69%,P0.05),紅細(xì)胞計(jì)數(shù)減少率(21.3%、17.2%、33.9%,P0.05),血紅蛋白水平減少率(25%、38%、43.4%,P0.05),TGAB水平升高[4.01(3.10-5.50),6.10(3.40-103.54),(0.00),P0.05],TPOAb水平升高(曾用名為TMAb)[3.75(2.70-5.50),6.00(3.30-126.50),(0.00),P0.05],T4[0.00,0.00(0.00-5.20),0.00,P0.05],TSH水平[0.00,0.00(0.00-9.80),0.00,P0.05],FT3水平[0.00,0.00(0.00-1.46),0.00,P0.05]雖然統(tǒng)計(jì)學(xué)有意義但FT3都在正常范圍內(nèi),臨床無意義。FT4水平下降[0.00(0.00-0.75),0.00(0.00-1.46),0.00,P0.05],尿膿細(xì)胞數(shù)(1.70±0.05,0.26±0.14,0.57±0.12,P0.05)、球蛋白水平升高(30.27±5.91,34.23±10.67,32.86±7.85,P0.05)、高密度脂蛋白(1.74±0.72,2.36±0.96,1.73±0.07,P0.05)采用二分類Logistic回歸分析SSA、SSB、RNP抗體、紅細(xì)胞、血紅蛋白均有統(tǒng)計(jì)學(xué)差異(P0.05),其中SSB陽性率,0R=6.43；血紅蛋白減少率最大OR=0.45。結(jié)論1、SLE合并HT發(fā)病平均年齡大,SLE合并HT占SLE患者的2.8%。2、SLE合并HT時(shí)血液系統(tǒng)受累減少,其中SSA抗體是保護(hù)性因素,RNP抗體、SSB抗體是危險(xiǎn)因素。3、HT在SLE患者的發(fā)病率與SLE的活動(dòng)期無關(guān)。
[Abstract]:Objective to study the incidence of Hashimotos thyroiditis (Thyroiditis HT) in systemic lupus erythematosus (SLE), and to explore the clinical and laboratory features of the two diseases in order to guide the diagnosis and treatment of HT. Methods 1029 patients with SLE in the second, first affiliated hospital of Kunming Medical University were studied by retrospective tabular record and telephone return visit. According to the experimental design, group A was divided into three groups: group A: 80 SLE patients with Thyroglobulin Antibodies (TgAb), abnormal thyroid peroxidase antibodies (TPOAb) but not up to the diagnostic criteria of Hashimoto's thyroiditis. The TgAb-TPOAb of the 80 SLE patients turned negative after half a year treatment) Group B: 29 patients with SLE complicated with HT (follow-up hospitalization or telephone visit, 29 SLE patients TgAb, TPOAb are still positive after six months of treatment and thyroid B ultrasound changes); Group C: 109 SLE patients were screened as control group according to the time of hospitalization in 920 SLE patients with normal TgAband TPOAb. The antinuclear antibody spectrum, urinary system, nervous system, blood system, liver and kidney function were selected as control group. Index characteristics of disease activity score. The counting data were tested by 蠂 ~ 2, the measurement data of normal distribution by ANOVA, the metrological data of skewness distribution by rank sum test, and the single factor with statistical significance was screened out. Then multiple factor two classification logistic regression analysis was used to find the independent risk factors of SLE complicated with HT. Results there were 29 cases with Hashimoto's thyroiditis in 1029 cases, the incidence was 2.8%. 涓夌粍鐨勭嚎綺掍綋M2闃蟲，

本文編號(hào)：2107281