器官專一性自體抗體與甲狀腺以外全身性風濕症狀的相關性並對奎寧的治療反應

Organ-specifi c autoantibodies associated with extrathyroid systemic rheumatic manifestation and responded to Hydroxychloroquine treatment

目的：研究甲狀腺過氧化脢抗體與甲狀腺球蛋白抗體在臨床與血清學上的表現，並在奎寧治療後之反應與對照組之比較。方法：我們搜尋臺大醫院資料庫中，從西元2009年到2011年間，有甲狀腺過氧化脢抗體與／或甲狀腺球蛋白抗體之病人。結果：從風濕免疫科和內分泌科門診，有93位病人測得甲狀腺過氧化脢抗體與／或甲狀腺球蛋白抗體。其中有69位病人有風濕相關之臨床症狀，以乾燥症且尤其是口乾為最常見之症狀（63.8%），其次為皮膚相關之症狀（40.6%），骨骼肌肉症狀（34.8%），反覆性流產（23.2%）。其中同時測得甲狀腺過氧化脢抗體與甲狀腺球蛋白抗體之病人有50.7%，以甲狀腺過氧化脢抗體比甲狀腺球蛋白抗體更常見。所有含風濕相關之臨床症狀的病人皆以奎寧治療。甲狀腺過氧化脢抗體在治療6個月後下降37.1%（p<0.01），相較於沒有治療之對照組。結論：病人測得甲狀腺過氧化脢抗體與／或甲狀腺球蛋白抗體可以有各種不同風濕相關之臨床症狀。經奎寧治療6個月後可有效降低抗體同時改善臨床症狀。

Objective: To elucidate the clinical and serology features of patients with positive thyroid peroxidase Ab (TPOAb) and/or thyroglobulin Ab (TgAb), as well as treatment response to hydroxychloroquine (HCQ) in these patients, compared with placebo. Methods: Between 2009 and 2011, patients with positive TPOAb and/or TgAb were enrolled in a study conducted in National Taiwan University Hospital. Their clinical and serological features were obtained by reviewing medical records and laboratory databases. Results: On the basis of the information reviewed, 93 patients with positive TPOAb and/or TgAb were identifi ed from the out patient department (OPD) of Rheumatology and Endocrinology. Sixty-nine patients with various rheumatic features where sicca syndrome, especially dry mouth, was the most common symptom (63.8%), followed by cutaneous anifestation (40.6%), musculoskeletal symptom (34.8%), and recurrent reproductive failure (23.2%). Their concurrent positive TPOAb and TgAb were 50.7%, where TPO Ab was more frequently discovered than was TgAb. Those with rheumatic features were treated with HCQ 200mg twice per day. Percentage of TPOAb titer decreased to 37.1 (p<0.01) after 6 months, compared with no TPOAb discrepancy of the placebo. Conclusion: Patients with positivity of TPOAb and/or TgAb could have various extra-thyroid rheumatic features. Treatment with HCQ for 6 months was convincing in decreasing those autoantibodies and concurrently improved some of the rheumatic symptoms and signs.