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A Cohort Study of Autoimmune Thyroid Diseases in Primary Sjögren's Syndrome in Northern Taiwan
自體免疫甲狀腺疾病於原發性修格連氏症候群在北台灣的世代分析研究
摘要
目的：許多全身性自體免疫疾病可以合併自體免疫甲狀腺疾病，如原發性修格連氏症候群(primary Sjögren's syndrome, SS)、類風濕性關節炎(rheumatoid arthritis, RA)、全身性紅斑狼瘡(systemic lupus erythematosus, SLE)等等。在台灣，自體免疫甲狀腺疾病與primary SS的關連性尚不清楚。爲了了解這兩個疾病的關連性，我們評估primary SS、RA和SLE病人的甲狀腺功能、抗甲狀腺自體抗體與自體免疫甲狀腺炎的發生率。方法：四十五位primary SS病人、四十位SLE病人和四十六位RA病人參加本研究。病人皆爲女性並且於西元2006年1月至2007年3月間在台北榮民總醫院追蹤檢查。我們測量這些病人血清中的抗甲狀腺過氧化酶抗體(anti-TPO antibody)、抗甲狀腺球蛋白抗體(anti-TG antibody)、游離甲狀腺素(free T4)和甲狀腺促進素(TSH)來做分析。結果：Primary SS病人的平均年齡爲55.1歲，RA病人的平均年齡爲55.7歲，SLE病人的平均年齡爲52.5歲。Anti-TPO antibody與anti-TG antibody在primary SS病人的發生率比在RA或SLE病人高{anti-TPO Ab: 26.7% (primary SS), 15% (SLE), 15.2% (RA); anti-TG Ab: 28.9% (primary SS), 15% (SLE), and17.4% (RA)}｡相較於甲狀腺機能亢進{primary SS (2.2%), RA (0%), SLE (2.5%)}，甲狀腺機能低下較常出現在這三種全身性自體免疫疾病{primary SS (15.6%), RA (4.3%), SLE (15.0%)}｡橋本氏甲狀腺炎出現在primary SS病人的頻率比出現在RA或SLE病人有統計學意義的增加 (primary SS vs.RA: 20% (9/45) vs. 4.3% (2/46), p=0.027; primary SS vs. SLE: 20% (9/45) vs. 5% (2/40), p=0.053)｡結論：在台灣，primary SS、RA和SLE的女性病人中，抗甲狀腺抗體和橋本氏甲狀腺炎出現在primary SS病人的頻率最高。因此，臨床上評估primary SS病人是否合併自體免疫甲狀腺疾病是很重要的。
並列摘要
Objective: Autoimmune thyroid diseases (ATD) can be found in many systemic autoimmune diseases, such as primary Sjögren's syndrome (SS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). This association between ATD and primary SS, RA, and SLE in Taiwan remains to be elucidated. In this study, the frequency of antithyroid antibodies, thyroid functional status, and the presence of autoimmune thyroiditis among those patients with primary SS, RA or SLE were investigated. Methods: Forty-five patients with primary SS, 40 patients with SLE, and 46 patients with RA were recruited for this study. All the patients were female and were followed up at Taipei Veterans General Hospital from January 2006 to March 2007. Sera from these patients were checked for anti-thyroid peroxidase (TPO) antibodies (Ab), anti-thyroglobulin (TG) Ab, the levels of free thyroxine (fT4) and thyroid-stimulating hormone (TSH). Results: The mean age of the patients in these groups were 55.1 years for the primary SS group, 52.5 years for SLE group, and 55.7 years for the RA group. The frequencies of anti-TPO Ab and anti-TG Ab in the primary SS group were higher than in the SLE or RA groups (anti-TPO Ab: 26.7% in primary SS, 15% in SLE, 15.2% in RA; anti-TG Ab: 28.9% in primary SS, 15% in SLE, and 17.4% in RA). However, the difference between any two of these three groups was not statistically significant. Compared to the low incidence of hyperthyroidism (primary SS: 2.2%, RA: 0%, SLE: 2.5%), the incidence of hypothyroidism is much higher in these three autoimmune diseases (primary SS: 15.6%, RA: 4.3%, SLE: 15.0%). The frequency of hypothyroidism was higher in primary SS or SLE than in RA. Hashimoto's thyroiditis was statistically found in primary SS patients than in RA or SLE patients (primary SS vs. RA: 20% (9/45) vs. 4.3% (2/46), p=0.027; primary SS vs. SLE: 20% (9/45) vs. 5% (2/40), p=0.053). Conclusion: In Taiwan, antithyroid autoantibodies and Hashimoto's thyroiditis are more frequently noted in female patients with primary SS than with RA or SLE. Therefore, it is clinically important to screen autoimmune thyroid diseases in patients with autoimmune diseases, especially those with primary SS.