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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 features and possible pathogenesis of autoimmune thyroid disease complicated with smoke syndrome (MMS). Methods Seven patients diagnosed as MMS by digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) in neurosurgery in Beijing Tiantan Hospital from 2007 to 2011 were summarized. All patients were diagnosed with endocrinology accompanied by autoimmune thyroid Disease, and other common causes of vascular stenosis. Results 7 patients, 2 males and 5 females. Five of them had Graves’ disease, two had Hashimoto’s thyroiditis, six had hyperthyroidism, and one had hypothyroidism. Six patients had elevated TPOAb, four had TRAb positive, and five had elevated TGAb. Seven of them were typical TICA, MCA and ACA stenosis or occlusion. Five patients had smoky vascular network in skull base and two patients with bilateral cerebral hemorrhage Arterial (PCA) stenosis. Six patients with hyperthyroidism were treated with methimazole combined with superficial temporal artery and middle cerebral artery bypass graft in one of seven patients. One patient with hypothyroidism was treated by oral Euthyrox or superficial temporal artery bypass grafting. All 7 patients had no operative complications during and after operation, and recovered well after discharge. Conclusion MMS with autoimmune thyroid disease may be related to abnormal thyroid function and autoimmune reaction. MMS is often necessary for thyroid function and antibody screening. Active treatment of thyroid disease is an important basis for the surgical treatment of MMS.