High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension
High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension
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DOI：
10.1378/chest.122.5.1668
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发表时间：
2002-11-01
期刊：
影响因子：
9.6
通讯作者：
Doyle, RL
中科院分区：
文献类型：
--
作者：
Chu, JW;Kao, PN;Doyle, RL
研究目的：甲状腺疾病与肺动脉高压（PAR）之间的关联已被报道，但这些疾病之间的发病关系尚不清楚。由于免疫系统功能障碍可能是这种关联的基础，我们试图确定自身免疫性甲状腺疾病（AITD）在PAH患者中的患病率。设计和环境：在单一学术机构进行前瞻性观察研究。患者：对63例连续患有PAH的成人（即持续肺动脉收缩压，> 25 mm Hg）进行临床、生化和血清学特征评估。测量方法：通过甲状腺肿的临床检查，以及促甲状腺素和游离甲状腺素的生化测量来确定甲状腺功能障碍。免疫系统功能障碍是通过血清学测量抗体甲状腺球蛋白和甲状腺过氧化物酶。为了调查自身免疫的遗传聚类，还确定了AITD的一级家族史。结果：31例患者（49%；95%可信区间[CI]， 37 ~ 62%）被诊断为AITD。18例患者为新诊断，9例患者需要开始药物治疗。PAH的诊断和治疗与AITD的诊断和治疗之间没有时间上的关系。16例患者（25%;95% CI, 15 - 36%）有24位一级亲属患有AITD。结论：大约一半的PAH患者伴有AITD。这两种情况可能通过共同的免疫遗传易感性联系在一起，阐明这种联系可能会促进对多环芳烃的病理生理和治疗的理解。对PAH患者隐匿性甲状腺功能障碍的系统监测可以预防右心衰的血流动力学恶化。
Study objectives: An association between thyroid disease and pulmonary arterial hypertension (PAR) has been reported, yet the pathogenetic relationship between these conditions remains unclear. Because immune system dysfunction may underlie this association, we sought to determine the prevalence of autoimmune thyroid disease (AITD) in patients with PAH.Design and setting: Prospective observational study at a single academic institution. Patients: Sixty-three consecutive adults with PAH (ie, sustained pulmonary artery systolic pressure, > 25 mm Hg) were evaluated for clinical, biochemical, and serologic features of AITD.Measurements: Thyroid gland dysfunction was determined by clinical examination for goiter, and by biochemical measurements of thyrotropin and free thyroxine. Immune system dysfunction was determined by serologic measurements of antibodies to thyroglobulin and thyroid peroxidase. First-degree family history of AITD also was ascertained in order to investigate for genetic clustering of autoimmunity.Results: Thirty-one patients (49%; 95% confidence interval [CI], 37 to 62%) received diagnoses of AITD. Eighteen patients were newly diagnosed, and 9 patients required the initiation of pharmacologic treatment. There was no chronologic relationship between the diagnosis or treatment of PAH and that of AITD. Sixteen patients (25%; 95% CI, 15 to 36%) had 24 first-degree family members with AITD.Conclusions: Approximately half of the patients with PAH have concomitant AITD. These two conditions may be linked by a common immunogenetic susceptibility, and the elucidation of this association may advance the understanding of the pathophysiology and treatment of PAH. Systematic surveillance for occult thyroid dysfunction in patients with PAH may prevent the hemodynamic exacerbation of right heart failure.