重症肌无力患者胸腺切除术后抗甲状腺自身抗体消失
Disappearance of Anti-Thyroid Autoantibodies following Thymectomy in Patients with Myasthenia Gravis.
作者信息
Rotondo Dottore Giovanna, Leo Marenza, Ricciardi Roberta, Maestri Michelangelo, Bucci Ilaria, Lucchi Marco, Melfi Franca, Guida Melania, De Rosa Anna, Petrucci Loredana, Ionni Ilaria, Lanzolla Giulia, Nicolì Francesca, Mantuano Michele, Ricci Debora, Latrofa Francesco, Mariotti Stefano, Marcocci Claudio, Marinò Michele
机构信息
Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Pisa, Italy.
Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa and University Hospital of Pisa, Pisa, Italy.
出版信息
Eur Thyroid J. 2021 Jun;10(3):237-247. doi: 10.1159/000510701. Epub 2020 Oct 6.
OBJECTIVES
The thymus plays a central role in immune tolerance, which prevents autoimmunity. Myasthenia gravis (MG) is commonly associated with thymoma or thymus hyperplasia, and it can coexist with autoimmune thyroid diseases. However, the role of the thymus in thyroid autoimmunity remains to be clarified, which we investigated here.
STUDY DESIGN
The study design entailed the inclusion of consecutive MG patients and the measurement of anti-thyroid autoantibodies at baseline and, limited to autoantibody-positive patients, also at 24 and 48 weeks. One hundred and seven MG patients were studied. The main outcome measure was the behaviour of anti-thyroglobulin autoantibodies (TgAbs) and anti-thyroperoxidase autoantibodies (TPOAbs) over time in relation to thymectomy.
RESULTS
Serum TgAbs and/or TPOAbs were detected in ∼20% of patients in the absence of thyroid dysfunction. The prevalence of positive serum TgAbs and/or TPOAbs decreased significantly ( = 0.002) over the follow-up period in patients who underwent thymectomy, but not in patients who were not thymectomized. When the analysis was restricted to TgAbs or TPOAbs, findings were similar. On the same line, there was a general trend towards a reduction in the serum concentrations of anti-thyroid autoantibodies in patients who underwent thymectomy, which was significant for TPOAbs ( = 0.009).
CONCLUSIONS
Our findings suggest a role of the thymus in the maintenance of humoral thyroid autoimmunity.
目的
胸腺在免疫耐受中起核心作用，可预防自身免疫。重症肌无力（MG）通常与胸腺瘤或胸腺增生相关，且可与自身免疫性甲状腺疾病共存。然而，胸腺在甲状腺自身免疫中的作用仍有待阐明，我们在此进行了研究。
研究设计
该研究设计包括纳入连续的MG患者，并在基线时测量抗甲状腺自身抗体，对于自身抗体阳性患者，在24周和48周时也进行测量。共研究了107例MG患者。主要观察指标是抗甲状腺球蛋白自身抗体（TgAbs）和抗甲状腺过氧化物酶自身抗体（TPOAbs）随时间与胸腺切除术相关的变化情况。
结果
在约20%无甲状腺功能障碍的患者中检测到血清TgAbs和/或TPOAbs。在接受胸腺切除术的患者中，随访期间血清TgAbs和/或TPOAbs阳性率显著降低（P = 0.002），而未接受胸腺切除术的患者则无此现象。当分析仅限于TgAbs或TPOAbs时，结果相似。同样，接受胸腺切除术的患者血清抗甲状腺自身抗体浓度总体呈下降趋势，其中TPOAbs下降显著（P = 0.009）。
结论
我们的研究结果提示胸腺在维持甲状腺体液自身免疫中发挥作用。
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