摘要
目的分析和探讨自身免疫性甲状腺疾病合并烟雾综合征(MMS)的临床特点及可能发病机制。方法总结北京天坛医院2007年至2011年于神经外科经数字减影血管造影(DSA)及磁共振血管成像(MRA)检查诊断为MMS的患者7例,所有患者经内分泌科确诊伴随自身免疫性甲状腺疾病,并除外血管狭窄的其他常见原因。结果 7例患者中,男2例,女5例。其中5例伴有Graves病,2例伴有桥本甲状腺炎;甲状腺功能亢进患者6例,甲状腺功能减退患者1例。6例患者TPOAb增高,4例患者TRAb阳性,5例患者TGAb增高。7例患者均为典型的颈内动脉末端(TICA)、大脑中动脉(MCA)、大脑前动脉(ACA)狭窄或闭塞,5例患者颅底可见烟雾状血管网,2例合并双侧大脑后动脉(PCA)狭窄。7例患者中6例甲状腺功能亢进患者经口服他巴唑联合颞浅动脉-大脑中动脉搭桥手术治疗,1例甲状腺功能减退患者经口服优甲乐联合颞浅动脉-大脑中动脉搭桥手术治疗。所有7例患者术中及术后未见手术并发症,恢复良好后出院。结论自身免疫性甲状腺疾病合并MMS可能与甲状腺功能异常及自身免疫反应等因素相关;MMS患者常规行甲状腺功能及抗体筛查十分必要;积极治疗甲状腺疾病是手术治疗MMS的重要基础。
Objective To analyze and explore the clinical manifestations and possible pathogenesis in patients concomitant with autoimmune thyroid disease(AITD) and Moyamoya syndrome(MMS).Methods Seven patients with MMS diagnosed were summarized by DSA and MRA from 2007 to 2011 in Tiantan Hospital.All these patients were diagnosed with AITD at the same time and also ruled out the common reasons for angiostenosis.Results A total of seven AITD patients(two male and five female) concomitant with MMS were screened during four years.Five patients were associated with Graves' disease while two patients were associated with Hashitoxicosis.Six patients were Hyperthyroid while one patient was hypothyroid.High level of TPOAb was found in six patients.Four patients were TRAb positive.High level of TGAb was found in five patients.All seven patients had typical stenosis or occlusion on terminal internal carotid arteries(TICA)/middle cerebral arteries(MCAs)/anterior cerebral arteries(ACAs),five of these patients with smoke-like vascular network in basal ganglia,and the other two patients accompanied with stenosis on bilateral proximal cerebral arteries(PCAs).Six patients with hyperthyroidism were treated with tapazole and bypass surgery to superficial temporal arteries and middle cerebral arteries,and one remaining patient with hypothyroidism was treated with Euthyrox and bypass surgery to superficial temporal arteries and MCAs.No patient developed complications during or after surgery and all patients recovered and were discharged.Conclusions AITD concomitant with MMS may correlate with abnormal thyroid function and autoimmune response.It is necessary to perform thyroid function test and antibody screening to MMS patients.It is essential to treat thyroid disease in MMS patients who are treated by surgery.
出处
《中华临床医师杂志（电子版）》
CAS
2011年第12期3523-3527,共5页
Chinese Journal of Clinicians(Electronic Edition)
