Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA.
Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, USA.
Rheumatology (Oxford). 2022 Jul 6;61(7):2942-2950. doi: 10.1093/rheumatology/keab817.
To study the prevalence, risk and clinical associations of hypothyroidism among several forms of vasculitis.
Patients with GCA, Takayasu's arteritis (TAK), PAN and the three forms of ANCA-associated vasculitis [AAV; granulomatosis with polyangiitis (GPA), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (EGPA)] enrolled in a prospective, multicentre, longitudinal study were included.
The study included data on 2085 patients [63% female, 90% White] with a mean age of 54.6 years (s.d. 17.2). Diagnoses were GCA (20%), TAK (11%), PAN (5%), GPA (42%), microscopic polyangiitis (8%) and EGPA (14%). Hypothyroidism was present in 217 patients (10%) (83% female), with a mean age 59.8 years (s.d. 14.5). Age- and sex-adjusted risk of hypothyroidism was GCA, odds ratio (OR) 0.61 (95% CI 0.41, 0.90); TAK, OR 0.57 (95% CI 0.31, 1.03); PAN, OR 0.59 (95% CI 0.25, 1.38); GPA, OR 1.51 (95% CI 1.12, 2.05); microscopic polyangiitis, OR 1.81 (95% CI 1.18, 2.80) and EGPA, OR 0.82 (95% CI 0.52, 1.30). Among patients with AAV, age- and sex-adjusted risk of hypothyroidism was higher with positive MPO-ANCA [OR 1.89 (95% CI 1.39, 2.76)]. The clinical manifestations of vasculitis were similar in patients with and without hypothyroidism, except transient ischaemic attacks, which were more frequently observed in patients with GCA and hypothyroidism (12% vs 2%; P = 0.001).
Differences in the risk of hypothyroidism among vasculitides may be due to genetic susceptibilities or immune responses. This study confirms an association of hypothyroidism with MPO-ANCA.
研究几种血管炎中甲状腺功能减退症的流行率、风险和临床关联。
本前瞻性、多中心、纵向研究纳入了巨细胞动脉炎（GCA）、Takayasu 动脉炎（TAK）、原发性中枢神经系统血管炎（PAN）和三种抗中性粒细胞胞质抗体相关性血管炎[肉芽肿性多血管炎（GPA）、显微镜下多血管炎和嗜酸性肉芽肿性多血管炎（EGPA）]患者。
该研究纳入了 2085 名患者的数据[63%为女性，90%为白人]，平均年龄为 54.6 岁（标准差 17.2）。诊断为 GCA（20%）、TAK（11%）、PAN（5%）、GPA（42%）、显微镜下多血管炎（8%）和 EGPA（14%）。217 名患者（10%）患有甲状腺功能减退症（83%为女性），平均年龄为 59.8 岁（标准差 14.5）。年龄和性别调整后甲状腺功能减退症的风险为 GCA，比值比（OR）为 0.61（95%置信区间 0.41，0.90）；TAK，OR 为 0.57（95%置信区间 0.31，1.03）；PAN，OR 为 0.59（95%置信区间 0.25，1.38）；GPA，OR 为 1.51（95%置信区间 1.12，2.05）；显微镜下多血管炎，OR 为 1.81（95%置信区间 1.18，2.80）；EGPA，OR 为 0.82（95%置信区间 0.52，1.30）。在抗中性粒细胞胞质抗体相关性血管炎患者中，抗髓过氧化物酶-抗中性粒细胞胞质抗体阳性者的甲状腺功能减退症风险经年龄和性别调整后更高[OR 1.89（95%置信区间 1.39，2.76）]。患有和不患有甲状腺功能减退症的血管炎患者的临床表现相似，除了短暂性脑缺血发作，在患有 GCA 和甲状腺功能减退症的患者中更为常见（12% vs 2%；P=0.001）。
血管炎之间甲状腺功能减退症风险的差异可能归因于遗传易感性或免疫反应。本研究证实了甲状腺功能减退症与抗髓过氧化物酶-抗中性粒细胞胞质抗体之间存在关联。
