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摘要: 目的 探讨甲状腺功能异常与免疫性血小板减少症(ITP)的关系。方法 回顾性研究2017年1月—2020年6月就诊于我院血液科并行甲状腺功能检查的112例ITP患者及我院抽样的737例体检中心检查的健康者。737例健康体检者中，甲状腺功能异常48例(甲状腺功能亢进症2例，亚临床甲状腺机能亢进6例和亚临床甲状腺机能减退40例)。112例ITP患者中，甲状腺功能正常83例(持续性ITP患者4例，慢性ITP患者5例，新诊断ITP患者74例)；甲状腺功能异常或诊断甲状腺疾病29例(持续性ITP患者4例，慢性ITP患者4例，新诊断ITP患者21例)，其中甲状腺功能亢进症5例，甲状腺功能减退症7例和亚临床甲状腺疾病17例(亚临床甲状腺机能亢进9例和亚临床甲状腺机能减退8例)。结果 112例ITP患者中甲状腺功能异常发生率为25.89%(29/112)，737例健康者中甲状腺功能异常发生率为6.51%(48/737)，二者甲状腺功能异常发生率比较差异有统计学意义(P< 0.05)。甲状腺功能异常的新诊断ITP患者(21例)与甲状腺功能正常的新诊断ITP患者(74例)间早期反应率比较，差异无统计学意义(80.95% vs 85.14%，P=0.643)；甲状腺功能异常的新诊断ITP患者与甲状腺功能正常的新诊断ITP患者在发展为慢性ITP的概率方面，治疗无效分析差异无统计学意义(47.62% vs 29.73%，P=0.126)，最佳情况分析差异有统计学意义(61.90% vs 29.73%，P=0.007)，最差情况分析差异无统计学意义(47.62% vs 47.30%，P=0.979)。结论 ITP患者比健康者甲状腺检查出现异常的发生率明显升高。甲状腺疾病对ITP患者治疗的早期反应未发现明显影响，甲状腺疾病可能影响ITP病程的发展。Abstract: Objective To investigate the relationship between thyroid dysfunction and immune thrombocytopenia(ITP).Methods A retrospective study was conducted on 112 ITP patients who received thyroid function examination in our hospital from January 2017 to June 2020 and 737 healthy people sampled from physical examination center of our hospital. There were 2 cases of hyperthyroidism, 6 cases of subclinical hyperthyroidism and 40 cases of subclinical hypothyroidism in 737 healthy people. Among 112 ITP patients, 83 cases had normal thyroid function, including 4 cases with persistent ITP, 5 cases with chronic ITP, and 74 cases with newly diagnosed ITP; the remaining 29 patients had thyroid dysfunction or diagnosis of thyroid disease(4 cases with persistent ITP, 4 cases with chronic ITP, 21 cases with newly diagnosed ITP), including 5 patients with hyperthyroidism, 7 patients with hypothyroidism, and 17 patients with subclinical thyroid disease(9 patients with subclinical hyperthyroidism and 8 patients with subclinical hypothyroidism).Results The incidence of thyroid disease or dysfunction was 25.89%(29/112) in ITP patients and 6.51%(48/737) in healthy people. There was significant difference in the incidence of thyroid disease or dysfunction between 2 groups(P< 0.05). There was no significant difference in the early response rate between newly diagnosed ITP patients with abnormal thyroid function(21 cases) and newly diagnosed ITP patients with normal thyroid function(74 cases)(80.95% vs 85.14%,P=0.643). There was no significant difference in the probability of developing chronic ITP between newly diagnosed ITP patients with abnormal thyroid function and newly diagnosed ITP patients with normal thyroid function(47.62% vs 29.73%,P=0.126), there was significant difference in the best case analysis(61.90% vs 29.73%,P=0.007), and there was no significant difference in the worst case analysis(47.62% vs 47.30%,P=0.979).Conclusion The incidence of thyroid abnormalities in ITP patients is significantly higher than that in healthy people. Thyroid disease has no significant effect on the early response of ITP patients. Thyroid disease may affect the development of ITP.
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Key words:
- immune thrombocytopenia /
- thyroid
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表 1 新诊断ITP患者中甲状腺功能正常者与甲状腺功能异常者间临床特征比较
特征 甲状腺功能正常组 甲状腺功能异常组 P 例数 74 21 性别/例(%) 0.044 男 32(43.24) 4(19.05) 女 42(56.76) 17(80.95) 年龄/岁 46(12~87) 46(13~82) 0.560 体重指数/(kg·m-2) 23.94(16.69~34.69) 23.23(16.65~34.52) 0.031 白细胞计数/(×109·L-1) 6.5(2.3~17.6) 5.7(2.3~9.7) 0.066 血红蛋白/(g·L-1) 134.5(56.2~176.0) 128.0(45.0~170.0) 0.149 血小板计数/(×109·L-1) 6(1~66) 10(2~63) 0.067 血小板计数<20×109/L/例(%) 71(95.95) 20(95.24) 0.887 血小板计数<10×109/L/例(%) 56(75.68) 11(52.38) 0.039 出血分数/分 4(0~9) 4(0~9) 0.928 糖皮质激素/例(%) 68(91.89) 19(90.48) 0.837 丙种球蛋白/例(%) 37(50.0) 12(57.14) 0.563 重组人血小板生成素/例(%) 38(51.35) 12(57.14) 0.639 
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表 2 甲状腺功能异常ITP患者与甲状腺功能正常ITP患者发展为慢性ITP发生率比较(治疗无效分析)
组别 慢性ITP人数 总人数 发生率/% 甲状腺功能异常ITP患者 10 21 47.62 甲状腺功能正常ITP患者 22 74 29.73 χ2 - - 2.344 P - - 0.126
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表 3 甲状腺功能异常ITP患者与甲状腺功能正常ITP患者发展为慢性ITP发生率比较(最佳情况分析)
组别 慢性ITP人数 总人数 发生率/% 甲状腺功能异常ITP患者 13 21 61.90 甲状腺功能正常ITP患者 22 74 29.73 χ2 - - 7.278 P - - 0.007
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表 4 甲状腺功能异常ITP患者与甲状腺功能正常ITP患者发展为慢性ITP发生率比较(最差情况分析)
组别 慢性ITP人数 总人数 发生率/% 甲状腺功能异常ITP患者 10 21 47.62 甲状腺功能正常ITP患者 35 74 47.30 χ2 - - 0.001 P - - 0.979
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| 引用本文: |
刘先栋, 张翠明, 杨林花. 免疫性血小板减少症与甲状腺功能异常关系研究[J]. 临床血液学杂志, 2022, 35(7): 474-478. doi: 10.13201/j.issn.1004-2806.2022.07.005
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| Citation: |
LIU Xiandong, ZHANG Cuiming, YANG Linhua. The relationship between immune thrombocytopenia and thyroid dysfunction[J]. J Clin Hematol, 2022, 35(7): 474-478. doi: 10.13201/j.issn.1004-2806.2022.07.005
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