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CN 22-1108/R
Volume 38 Issue 7
Jul.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(7): 1521-1528

Features and prognosis of Hashimoto's thyroiditis in patients with primary biliary cholangitis

DOI: 10.3969/j.issn.1001-5256.2022.07.013

  • Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, China

Research funding:

National Natural Science Foundation of China Projects (81660102);

National Natural Science Foundation of China Projects (81360072)

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  • Corresponding author: TANG Yingmei, tangyingmei_med@kmmu.edu.cn (ORCID: 0000-0002-0731-4198)
  • Received Date: 2021-11-01
  • Accepted Date: 2021-12-22
  • Published Date: 2022-07-20
    Abstract
  •   Objective  To investigate the clinical features, related factors, and prognosis of Hashimoto's thyroiditis (HT) in patients with primary biliary cholangitis (PBC).  Methods  A retrospective analysis was performed for the patients who were diagnosed with PBC in The Second Affiliated Hospital of Kunming Medical University from January 2018 to December 2020, among whom 301 patients underwent thyroid function tests and had complete clinical data. According to the involvement of thyroid disease, they were divided into HT group with 83 patients and non-HT group with 88 patients. The two groups were compared in terms of general data, clinical features, and laboratory examination, and the factors and prognostic features of HT in patients with PBC were analyzed. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test and the Bonferroni correction test were used for comparison of categorical data between two group; a Spearman correlation analysis was used to investigate correlation, and a binary logistic regression analysis or multiple linear regression analysis was used for multivariate analysis.  Results  The patients with PBC often had extrahepatic autoimmune diseases, and the prevalence rate of HT was 27.6%. Compared with the non-HT group, the HT group had significantly higher number of female patients (χ2=9.547, P < 0.05), Child-Pugh score (Z=-3.100, P < 0.05), and levels of IgA (Z=-1.992, P < 0.05), interleukin-6 (IL-6) (Z=-1.969, P < 0.05), thyroglobulin antibody (TgAb) (Z=-9.612, P < 0.05), and thyroid peroxidase antibody (TPOAb) (Z=-9.739, P < 0.05), significantly higher incidence rates of liver cirrhosis (χ2=8.807, P < 0.05), weakness (χ2=4.951, P < 0.05), poor appetite (χ2=6.636, P < 0.05), and abdominal distension (χ2=7.977, P < 0.05), and significantly lower levels of total cholesterol (Z=-2.743, P < 0.05), total triglyceride (Z=-2.332, P < 0.05), low-density lipoprotein(Z=-2.604, P < 0.05), and C3 (t=5.063, P < 0.05). Increases in Child-Pugh score (odds ratio [OR]=1.486, 95% confidence interval [CI]: 1.06-2.083, P < 0.05), TgAb (OR=1.032, 95%CI: 1.012-1.052, P < 0.05), and TPOAb (OR=1.007, 95%CI: 1.002-1.012, P < 0.05) were independent risk factors for the development of HT in PBC patients. Old age (t=9.147, P < 0.05), no response to UDCA treatment (t=-2.727, P < 0.05), increases in AST, ALP, total bilirubin, IgA, and IL-6 (t=2.121, 2.446, 10.114, 4.162, and 2.033, P < 0.05), reductions in total protein, high-density lipoprotein, C3, and C4 (t=-3.384, -3.887, -2.440, and -2.422, P < 0.05), comorbidities hepatic encephalopathy and ascites (t=3.685 and 6.744, P < 0.05), and positive gp210 antibodies (t=3.125, P < 0.05) were independent risk factors for the increase in Mayo risk score, which suggested a poor prognosis. PBC with HT (t=-0.077, P > 0.05) was not an independent risk factor for the increase in Mayo risk score and did not affect the prognosis of patients.  Conclusion  Patients with PBC often have extrahepatic autoimmune diseases, among which thyroid diseases are the most common disease, especially autoimmune thyroiditis, and the patients with PBC and HT have more complications and clinical symptoms. Progression of liver disease and increases in the thyroid-associated antibodies TgAb and TPOAb are independent risk factors for the development of HT, but comorbidity of HT does not affect the prognosis of patients with PBC.

     

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