Evangelopoulou M E, Alevizaki M, Toumanidis S, Piperingos G, Mavrikakis M, Sotou D, Evangelopoulou K, Koutras D A
Department of Medical Therapeutics, Alexandra Hospital, Athens University School of Medicine, Greece.
Thyroid. 1999 Oct;9(10):973-7. doi: 10.1089/thy.1999.9.973.
A coexistence of mitral valve prolapse (MVP) with autoimmune thyroid disease (AITD) has been described, but there are not sufficient data to explain this association. The aim of the present study was to investigate the prevalence of MVP in patients with AITD and to evaluate whether any correlation between MVP and certain immunological parameters exists. M-mode, two-dimensional Doppler echocardiography was performed in 29 patients with Graves' disease (GD), 35 with Hashimoto's thyroiditis (HT), 20 with nonautoimmune goiter, and 30 normal controls. Serum samples were examined for antinuclear antibodies (ANA), antibodies against extractable nuclear antigen (ENA), antiphospholipid antibodies (aCL), rheumatoid factor (RF), thyroid autoantibodies (TAAb), immunoglobulins and C3, C4. Eight of 29 GD patients and 8 of 35 HT patients had MVP, while none of the control group and 2 of 20 of the simple goiter group had MVP (p < 0.05). ANA were detected at low titers in 5 of 8 in MVP(+) GD versus 3 of 21 in MVP(-) GD (p < 0.05). In the HT group the MVP(+) patients had a significantly higher incidence of ANA and ENA, 5 of 8 and 2 of 8 versus 5 of 27 and 0 of 27 of MVP(-) patients, respectively, p < 0.05. A statistically significant higher incidence of aCL was found in HT MVP(+) patients. (3/8) versus HT MVP(-) 1/27, p < 0.05. RF levels (immunoglobulin A [IgA]) were significantly higher in MVP(+) patients. The association of MVP with nonorgan-specific autoantibodies indicates that MVP may also be an autoimmune disease. It is possible that patients with AITD who also have MVP may be at an increased risk to develop systemic autoimmunity.
二尖瓣脱垂（MVP）与自身免疫性甲状腺疾病（AITD）并存的情况已有报道，但尚无足够数据解释这种关联。本研究的目的是调查AITD患者中MVP的患病率，并评估MVP与某些免疫参数之间是否存在相关性。对29例格雷夫斯病（GD）患者、35例桥本甲状腺炎（HT）患者、20例非自身免疫性甲状腺肿患者和30例正常对照者进行了M型、二维多普勒超声心动图检查。检测血清样本中的抗核抗体（ANA）、抗可提取核抗原抗体（ENA）、抗磷脂抗体（aCL）、类风湿因子（RF）、甲状腺自身抗体（TAAb）、免疫球蛋白以及C3、C4。29例GD患者中有8例、35例HT患者中有8例存在MVP，而对照组和20例单纯甲状腺肿组中均无MVP（p<0.05）。MVP（+）的GD患者中有5/8低滴度检测到ANA，而MVP（-）的GD患者中为3/21（p<0.05）。在HT组中，MVP（+）患者的ANA和ENA发生率显著更高，分别为5/8和2/8，而MVP（-）患者分别为5/27和0/27，p<0.05。HT的MVP（+）患者中aCL的发生率在统计学上显著更高（3/8），而HT的MVP（-）患者为1/27，p<0.05。MVP（+）患者的RF水平（免疫球蛋白A[IgA]）显著更高。MVP与非器官特异性自身抗体的关联表明MVP可能也是一种自身免疫性疾病。患有AITD且同时患有MVP的患者可能有更高的发生全身性自身免疫的风险。
