老年桥本甲状腺炎人群自身免疫性肝炎的发生情况调查及相关影响因素分析

摘要/Abstract

摘要： 目的探究老年桥本甲状腺炎(HT)人群自身免疫性肝炎(AIH)的发生情况及相关影响因素。方法随机选取锦州医科大学附属第一医院2020年4月至2023年4月接诊的老年HT患者152例。收集患者的人口学基线资料,检测患者的血清抗核抗体(ANA)、抗线粒体抗体、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ-谷氨酰转肽酶、碱性磷酸酶、胸腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)、免疫球蛋白G(IgG)、IgM、γ球蛋白的表达水平,根据老年HT患者是否合并AIH分为合并组和非合并组,筛查老年HT人群合并AIH的影响因素,构建老年HT人群合并AIH预测模型并进行验证。结果 152例患者中合并AIH 28例,发病率18.42%。两组患者的抗线粒体抗体、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ-谷氨酰转肽酶、碱性磷酸酶、IgM比较,差异无统计学意义(P>0.05);合并组的血清ANA阳性占比、TGAb、TPOAb、IgG、γ球蛋白分别为85.71%、(72.51±16.92)IU/mL、(65.29±13.08)IU/mL、(20.35±4.09)g/L、(3.52±0.91)g/L、(26.83±4.05)%,高于非合并组[66.13%、(50.04±15.31)IU/mL、(47.21±12.64)IU/mL、(17.52±3.91)g/L、(3.17±0.84)g/L、(21.31±3.27)%,P<0.05]。ANA阳性、TGAb、TPOAb、IgG、γ球蛋白是老年HT人群合并AIH的危险因素(P<0.05)。模型预测老年HT人群合并AIH的灵敏度为0.844(95%CI:0.731~0.952),特异度为0.813(95%CI:0.706~0.921),ROC曲线下面积(AUC)为0.828(95%CI:0.721~0.936)。结论老年HT患者合并AIH的占比较高,且AIH的发生与ANA、TGAb、TPOAb、IgG、γ球蛋白表达有关。

关键词: 桥本甲状腺炎, 自身免疫性肝炎, 发病现状, 影响因素

Abstract: Objective To explore the occurrence and related influencing factors of autoimmune hepatitis (AIH) in the elderly population with Hashimoto′s thyroiditis (HT). Methods A total of 152 elderly patients with HT were enrolled from April 2020 to April 2023 in First Affiliated Hospital of Jinzhou Medical University, to investigate the incidence of HT combined with autoimmune hepatitis (AIH). Baseline demographic data of the patients was collected, and their serum levels of antinuclear antibodies (ANA), anti-mitochondrial antibodies, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, thyroid globulin antibody (TGAb), thyroid peroxidase antibody (TPOAb), immunoglobulin G (IgG), immunoglobulin M (IgM), and gamma globulin were tested. Based on whether elderly HT patients were combined with AIH, they were divided into combined group and non-combined group. The influencing factors for the occurrence of AIH in elderly HT population were screened, and a model for predicting the occurrence of AIH in elderly HT population was constructed and validated. Results Among the 152 patients, 28 cases were complicated with AIH, with an incidence rate of 18.42%. There was no statistically significant difference (P>0.05) in the levels of anti-mitochondrial antibodies, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, and IgM between the two groups of patients. The proportion of serum ANA positivity, TGAb, TPOAb, IgG, and gamma globulin in the combined group were 85.71%, (72.51 ± 16.92) IU/mL, (65.29 ± 13.08) IU/mL, (20.35 ± 4.09) g/L, (3.52 ± 0.91) g/L, and (26.83 ± 4.05)%, respectively, which were higher than those in the non-combined group [66.13%, (50.04 ± 15.31) IU/mL, (47.21 ± 12.64) IU/mL, (17.52 ± 3.91) g/L, (3.17 ± 0.84) g/L, and (21.31 ± 3.27)%, P<0.05]. ANA positivity, TGAb, TPOAb, IgG, and gamma globulin were identified as risk factors for the occurrence of AIH in elderly HT population (P<0.05). The sensitivity, specificity, and an area under the curve of the model for predicting the occurrence of AIH in elderly HT population were 0.844 (95% CI: 0.731~0.952), 0.813 (95% CI: 0.706~0.921), and 0.828 (95% CI: 0.721~0.936). Conclusion Elderly patients with HT have a higher incidence of AIH, and the occurrence of AIH is associated with the expression of ANA, TGAb, TPOAb, IgG, and gamma globulin.

Key words: Hashimoto′s thyroiditis, Autoimmune hepatitis, Current situation of the disease, Influence factor

张雨, 杨帆, 林本瑞. 老年桥本甲状腺炎人群自身免疫性肝炎的发生情况调查及相关影响因素分析[J]. 肝脏, 2025, 30(8): 1115-1119.

ZHANg Yu, YANG Fan, LIN Ben-rui. Investigation and analysis of the occurrence of autoimmune hepatitis in the elderly population with Hashimoto′s thyroiditis, and related influencing factors[J]. Chinese Hepatolgy, 2025, 30(8): 1115-1119.

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