Isıl Eser SIMSEK, SAYGIN ABALI, Mujde Tuğba ÇOGURLU, Metın AYDOGAN

Kronik Spontan Ürtikerli Çocuklarda Otoimmün Tiroid Hastalığı için Risk Faktörleri

Kronik spontan ürtikerin (KSÜ) etiyolojisi çoğunlukla idiyopatik olmakla birlikte, hastaların bir kısmında patogenezde otoimmünitenin rol oynadığını destekleyen çalışmalar vardır. KSÜ ve tiroid otoimmünitesi birlikteliği çoğunlukla erişkinlerde araştırılmıştır; ancak, çocuklarda veriler sınırlıdır. Bu çalışmada, KSÜ tanısı almış çocuklarda anti tiroid peroksidaz (anti-TPO) antikor pozitifliği sıklığının saptanması ve otoimmun tiroid hastalığı için risk faktörlerinin belirlenmesi amaçlanmıştır. Bu retrospektif tanımlayıcı çalışmada, iki farklı merkezde KSÜ tanısı ile izlenen 126 hasta değerlendirilmiştir. Hastaların demografik ve klinik özellikleri, eşlik eden bağ doku hastalığı, otoimmün hastalık ve/veya allerjik hastalıkları ile her iki merkezde KSÜ hastalarında rutin olarak yapılan tam kan sayımı, total IgE, antinükleer antikor (ANA), anti-TPO antikor, serbest tiroksin (sT4) ve tirotiropin (TSH) düzeylerini içeren laboratuvar sonuçları; deri prick testi ve otolog serum deri testi (OSDT) sonuçları dosya verilerinden elde edildi. Anti-TPO pozitifliği saptanan hastaların tiroid ultrasanografisi bulguları da kaydedildi. Çalışmamızda 5 (%4.0) hastada anti-TPO pozitifliği saptandı. Bu hastaların 3’ünde tiroid US’de parankim heterojenitesi mevcuttu. ANA pozitifliği hastaların %10.2’sinde saptanmıştı. Anti-TPO pozitifliği olan hastalarda ANA pozitifliği anlamlı olarak yüksek idi (sırasıyla %60 ve %7.4, p=0.003). Dört hastada vitiligo tanısı mevcuttu ve bu hastalarda anti-TPO pozitifliği, vitiligo tanısı olmayan KSÜ tanılı hastalara göre istatistiksel olarak anlamlı olmamakla birlikte daha fazla saptandı (sırasıyla %20 ve %2.5, p=0.151) Kronik spontan ürtikerli çocuklarda ANA pozitifliği otoimmün tiroid hastalığı için risk faktörü olabilir. KSÜ’lü çocuklarda vitiligo ve otoimmun tiroid hastalığı ilişkisi daha geniş kohortlarda araştırılmalıdır.

Anahtar Kelimeler:

kronik ürtiker, anti tiroid peroksidaz antikoru, tiroid otoimmünitesi, sistemik lupus eritematozus, vitiligo

The Risk Factors for Autoimmune Thyroid Disorder in Children with Chronic Spontaneous Urticaria

Although the etiology of chronic spontaneous urticaria (CSU) in children is mostly idiopathic, there are studies supporting the autoimmune pathogenesis of disease in a subset of patients. CSU and autoimmune thyroid disease coexistence has been explored mostly in adults; however data in children is scarce. The aim of this study was to verify frequency of anti thyroid peroxidase (anti-TPO) antibody positivity and risk factors for autoimmune thyroid disorder in the children with CSU. In this retrospective descriptive study, a total of 126 children with CSU in two different centers were evaluated. The demographic and clinical features, coexisting connective tissue diseases, autoimmune and/or allergic diseases and complete blood count, total IgE, antinuclear antibody (ANA), anti-TPO antibody, free thyroxine (fT4), thyroid-stimulating hormone (TSH), skin prick test and autologous serum skin test (ASST) results that routinely performed for CSU in both centers were collected from medical records. Thyroid ultrasonography findings were also recorded in the patients with positive anti-TPO. Anti-TPO was positivite in 5 (4.0%) patients. Heterogenous paranchyme on thyroid US was detected in 3 of those. ANA was positive 10.1% of the patients. In anti-TPO positive patients, ANA positivity was significantly higher (60% vs 7.4%, respectively; p=0.003). Vitiligo was detected in 4 (3.2%) of patients and although it is not significant statistically, these patients had higher frequency of anti-TPO positivity compare to those without vitiligo (20% vs 2.5%, respectively; p=0.151). ANA positivity may be a risk factor for autoimmune thyroid disorder in patients with chronic spontaneous urticaria. Relationship between vitiligo and autoimmun thyroid disorder should also be investigated in patients with CSU in larger cohorts

Keywords:

Chronic urticaria, anti thyroid peroxidase antibody, thyroid autoimmunity, systemic lupus erythematosus, vitiligo,

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