Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Allergy. 2017 Oct;72(10):1440-1460. doi: 10.1111/all.13182. Epub 2017 May 22.
Patients with chronic spontaneous urticaria (CSU) are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG antithyroid autoantibodies (AAbs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase (TPO) are more often elevated in CSU than those of other IgG antithyroid AAbs (strong evidence). Levels of IgG antithyroid AAbs are more often elevated in adult patients with CSU than in children (strong evidence). Patients with CSU exhibit significantly higher levels of IgG antithyroid AAbs (strong evidence) and IgE-anti-TPO (weak evidence) than controls. Elevated IgG antithyroid AAbs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age, or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in patients with CSU (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves' disease (strong evidence). Thyroid dysfunction is more common in adult patients with CSU than in children (strong evidence) and in female than in male patients with CSU (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes, and complement.
患有慢性自发性荨麻疹（CSU）的患者通常被认为患有其他自身免疫性疾病，包括自身免疫性甲状腺疾病。在这里，我们系统地评估了 CSU 患者甲状腺自身免疫和反之亦然的文献。CSU 与 IgG 抗甲状腺自身抗体（AAb）水平升高之间存在很强的联系，大多数大量研究报告的比率≥10％。CSU 中甲状腺过氧化物酶（TPO）的 IgG 水平升高比其他 IgG 抗甲状腺 AAb 更为常见（强证据）。与儿童相比，成人 CSU 患者的 IgG 抗甲状腺 AAb 水平升高更为常见（强证据）。与对照组相比，CSU 患者的 IgG 抗甲状腺 AAb 和 IgE-抗 TPO 水平显著升高（强证据）。CSU 中升高的 IgG 抗甲状腺 AAb 与糖皮质激素的使用有关（弱证据），但与疾病持续时间或严重程度/活动度、性别、年龄或 ASST 反应无关（证据不一致）。CSU 患者甲状腺功能障碍的发生率增加（强证据）。甲状腺功能减退和桥本甲状腺炎比甲状腺功能亢进和格雷夫斯病更为常见（强证据）。与儿童相比，成人 CSU 患者（强证据）和女性 CSU 患者（弱证据）的甲状腺功能障碍更为常见。与对照组相比，患有甲状腺自身免疫的 CSU 患者中荨麻疹包括 CSU 更为常见（弱证据）。CSU 可以对左甲状腺素或其他甲状腺药物的治疗反应而改善（强证据）。CSU 患者伴甲状腺自身免疫的发病机制可能包括针对自身抗原的 IgE、免疫复合物和补体。
