原发性胆汁性胆管炎合并桥本甲状腺炎的临床特点及其转归

摘要/Abstract

摘要： 目的分析原发性胆汁性胆管炎合并桥本甲状腺炎的临床特点及其转归。方法选取2020年2月至2022年2月在首都医科大学附属北京朝阳医院确诊为原发性胆汁性胆管炎并进行甲状腺检查的患者60例,根据是否发生桥本甲状腺炎分为发生组(n=35)和未发生组(n=25)。比较发生组、未发生组的临床特征及发生组预后情况。结果发生组的Child-Pugh评分、发生肝硬化、乏力、消化不良、腹胀、水肿症状的占比及IgA、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体水平分别为(8.3±1.2)、85.7%、91.4%、85.7%、91.4%、85.7%、(2.9±1.2)g/L、(217.5±102.3)IU/mL、(192.6±62.4)IU/mL,均高于未发生组[分别为(5.2±1.1)、48.0%、60.0%、40.0%、48.0%、48.0%、(2.0±0.5)g/L、(10.2±3.6)IU/mL、(11.4±4.6)IU/mL],发生组总胆固醇、甘油三酯、低密度脂蛋白、补体C3的水平分别为(4.3±1.2)μmol/L、(1.2±0.2)μmol/L、(2.5±0.2)mmol/L、(0.5±0.2)g/L,均低于未发生组[分别为(5.8±2.3)μmol/L、(1.6±0.8)μmol/L、(3.0±1.2)mmol/L、(0.8±0.2)g/L,P<0.05]。发生组35例患者随访至2023年2月,10例(28.6%)患者出现腹水(5例),肝功能不全(4例),肝性脑病(1例);2例(5.7%)患者由于术后脑出血而死亡;5例(14.3%)患者出现术后复发性出血,1年内2例死亡,生存率为94.3%。结论原发性胆汁性胆管炎合并桥本甲状腺炎的概率很高,预后不佳,Child-Pugh分级、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体是影响上述病例死亡发生的危险因素。

关键词: 原发性胆汁性胆管炎, 桥本甲状腺炎, 临床特点, 临床转归

Abstract: Objective To analyze the occurrence, clinical characteristics, and clinical outcomes of Hashimoto′s thyroiditis in patients with primary biliary cholangitis. Methods Sixty patients who were diagnosed with primary biliary cholangitis and underwent thyroid examination in Beijing Chaoyang Hospital, Capital Medical University between February 2020 and February 2022 were selected. They were divided into the occurrence group (n=35) and the non-occurrence group (n=25) according to whether Hashimoto′s thyroiditis occurred. The clinical characteristics and prognosis of the occurrence and non-occurrence groups were compared. Results In the occurrence group, the Child-Pugh grade, the proportion of cirrhosis and other symptoms such as malaise, dyspepsia, abdominal distension, edema, and the levels of immunoglobulin A (IgA), thyroglobulin antibody, and thyroid peroxidase antibody were (8.3±1.2), 85.7%, 91.4%, 85.7%, 91.4%, 85.7%, (2.9±1.2) g/L, (217.5± 102.3) IU/mL, and (192.6±62.4) IU/mL, which were higher than those in the non-occurrence group [(5.2±1.1), 48.0%, 60.0%, 40.0%, 48.0%, 48.0%, 48.0%, (2.0±0.5) g/L, (10.2±3.6) IU/mL, and (11.4±4.6) IU/mL, respectively]. The levels of total cholesterol, triglycerides, low-density lipoprotein (LDL), and complement C3 in the occurrence group were (4.3±1.2)μmol/L, (1.2±0.2) μmol/L, (2.5±0.2) mmol/L, (0.5±0.2) g/L, respectively, which were lower than those in the non-occurrence group [(5.8±2.3) μmol/L, (1.6±0.8)μmol/L, (3.0±1.2) mmol/L, and (0.8±0.2) g/L, P<0.05]. Thirty-five patients were followed up until February 2023. Ten (28.6%) patients developed peritoneal effusion (n=5), hepatic insufficiency (n=4), and hepatic encephalopathy (n=1), and 2 (5.7%) patients died due to postoperative cerebral hemorrhage. Five (14.3%) patients developed recurrent postoperative hemorrhage, 2 died within one year, and the survival rate was 94.3%. Conclusion Patients with primary biliary cholangitis have a high probability of developing Hashimoto′s thyroiditis, and their prognosis is poor. Child-Pugh grade of liver function, thyroglobulin antibody and thyroid peroxidase antibody are the risk factors that affect the prognosis of the above cases.

Key words: Primary biliary cholangitis, Hashimoto′s thyroiditis, Clinical features, Clinical regression

杜丽川, 高茹, 高岩. 原发性胆汁性胆管炎合并桥本甲状腺炎的临床特点及其转归[J]. 肝脏, 2025, 30(6): 829-832.

DU Li-chuan, GAO Ru, GAO Yan. Occurrence and clinical characteristics of Hashimoto′s thyroiditis with primary biliary cholangitis and its clinical regression[J]. Chinese Hepatolgy, 2025, 30(6): 829-832.

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