目的：探讨IgG4相关性桥本甲状腺炎（ HT）患者血清IgG4水平及其临床意义。方法：酶联免疫吸附法测定129例HT患者血清IgG4水平，并根据IgG4水平将患者分为IgG4组（IgG4≥135 mg／dl）和非IgG4组（IgG4＜135 mg／dl）；电化学发光法测定血清甲状腺激素、甲状腺过氧化物酶抗体（ TPOAb）、甲状腺球蛋白抗体（ TgAb）；甲状腺超声影像检查。结果：HT患者血清TPOAb与同时测定的IgG4水平（r＝0.4371，P＝0.0127）和IgG4／IgG比值（r＝0.3962，P＝0.0235）呈显著正相关。与非IgG4组（97例）比较，IgG4组（32例）：①平均患病年龄趋年轻化（P＝0.0293）；②较高的血清TPOAb（P＝0.0021）、TgAb（P＝0.0128）水平；③超声影像：更易形成甲状腺结节（P＝0.0226）；④多因素Logistic回归分析结果提示，血清IgG4、TPOAb水平是患甲状腺结节危险因素，OR值分别为1.672（P＝0.021）、2.549（P＝0.014）。结论：IgG4相关性HT患者存在相应的临床特征。对于血清中IgG4水平明显升高的HT患者，应更加密切监测甲状腺功能及形态变化。%Objective:To explore the serum IgG4 level in patients with IgG4-related Hashimoto thyroiditis(IgG4 HT),and its clinical implications.Methods:The serum IgG4 was determined in 129 patients with HT using enzyme-linked immunosorbent assays and classified into two subgroups based on IgG4 level:IgG4 HT group(IgG4≥135 mg/dl)and non-IgG4 HT group(IgG4<135 mg/dl).And the levels of serum thyroid hormone and thyroid peroxidase antibodies(TPOAb)and thyroglobulin antibodies(TgAb)were measured by electro-chemiluminescence immunoassay.Ultrasonic imaging of the thyroid gland were detected.Results:The TPOAb levels correlated significantly with both serum IgG4 levels(r=0.437 1,P=0.012 7)and IgG4/IgG ratios(r=0.396 2,P=0.023 5)in the patients with HT.Compared with that of non-IgG4 HT group(n=97),IgG4 HT group(n=32):①The mean age was lower(P=0.029 3);②Higher levels of serum TPOAb(P=0.002 1)and TgAb(P=0.012 8);③Ultrasound imaging:the more obvious thyroid nodule(P=0.022 6);④Logistic regression analysis showed that serum IgG4 and TPOAb were the risk factor for thyroid nodules(OR=1.672,P=0.021;2.549,P=0.014 ).Conclusion: IgG4 HT patients existed corresponding clinical characteristics.For the HT-patients with elevated serum IgG4,thyroid function and morphology should were more closely monitored.
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