Thyroid Cancer in Systemic Lupus Erythematosus: A Case-Control Study
Thyroid Cancer in Systemic Lupus Erythematosus: A Case-Control Study
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DOI：
10.1210/jc.2009-0677
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发表时间：
2010-01-01
影响因子：
5.8
通讯作者：
Bombardieri, Stefano
中科院分区：
文献类型：
--
作者：
Antonelli, Alessandro;Mosca, Marta;Bombardieri, Stefano
背景：虽然治疗的进步使系统性红斑狼疮 (SLE) 患者的寿命更长，但这些患者中几种类型癌症的发病率似乎正在增加。目的：我们使用一项前瞻性研究来调查 SLE 患者中甲状腺癌的患病率和特征。设计和患者：将 153 名未选择的 SLE 患者中甲状腺癌的患病率与两个基于人群、性别和年龄匹配的对照组进行比较：1) 459 名受试者来自碘缺乏地区（碘缺乏对照）和2）来自碘充足地区的459名受试者（碘充足对照）。通过测量循环甲状腺激素和自身抗体、甲状腺超声检查以及必要时进行细针抽吸细胞学检查来评估甲状腺功能。 主要结果和结果：SLE 患者循环 TSH、抗甲状腺球蛋白和抗甲状腺过氧化物酶抗体水平显着升高（所有 P < 0.001）。此外，SLE 患者的甲状腺功能减退症患病率也较高（P < 0.001）。 SLE 患者中检出 5 例甲状腺乳头状癌，而碘缺乏对照者中未观察到病例（P = 0.001），碘充足对照者中仅观察到 1 例（P = 0.001）。在确诊甲状腺癌的 SLE 患者中，80% 表现出甲状腺自身免疫的证据，而无甲状腺癌的 SLE 患者中只有 31% 表现出甲状腺自身免疫的证据（P = 0.02）。 结论：这些数据表明，SLE 患者中甲状腺乳头状癌的患病率高于年龄匹配的对照者，特别是甲状腺自身免疫患者。因此，建议在随访这些患者期间仔细监测甲状腺。 (临床内分泌代谢杂志 95: 314-318, 2010)
Context: Although advances in treatment have permitted patients with systemic lupus erythematosus (SLE) to live longer, the rates of several types of cancers in these patients appear to be increasing.Objective: We used a prospective study to investigate the prevalence and features of thyroid cancer in SLE patients.Design and Patients: The prevalence of thyroid cancer in 153 unselected SLE patients was compared with that in two population-based, gender-and age-matched control groups: 1) 459 subjects from an iodine-deficient area (iodine-deficient control) and 2) 459 subjects from an iodine-sufficient area (iodine-sufficient control). Thyroid function was assessed by measuring circulating thyroid hormones and autoantibodies, thyroid ultrasonography, and where necessary, fine-needle aspiration cytology.Main Outcome and Results: The levels of circulating TSH, and anti-thyroglobulin and anti-thyroperoxidase antibodies were significantly higher in SLE patients (P < 0.001 for all). In addition, patients with SLE also exhibited a higher prevalence of hypothyroidism (P < 0.001). Five cases of papillary thyroid cancer were detected among SLE patients, whereas no cases were observed among iodine-deficient controls (P = 0.001), and only one case was observed among iodine-sufficient controls (P = 0.001). Among SLE patients with confirmed thyroid cancer, 80% showed evidence of thyroid autoimmunity, whereas only 31% of SLE patients without thyroid cancer exhibited evidence of thyroid autoimmunity (P = 0.02).Conclusions: These data suggest that the prevalence of papillary thyroid cancer in SLE patients is higher than in age-matched controls, particularly in patients with thyroid autoimmunity. Consequently, careful thyroid surveillance is recommended during the follow-up of these patients. (J Clin Endocrinol Metab 95: 314-318, 2010)