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中华产科急救电子杂志 ›› 2024, Vol. 13 ›› Issue (01) : 33 -40. doi: 10.3877/cma.j.issn.2095-3259.2024.01.007

论著

IgG4相关甲状腺疾病合并妊娠一例并文献复习
崔骞文1, 汪燕兰1, 李晴1, 赵平月1, 徐一菲1, 袁知东1, 韩巍1, 张笑薇1, 黄磊1, 樊尚荣1,()   
  1. 1. 518035 深圳,北京大学深圳医院产科
  • 收稿日期:2023-11-07 出版日期:2024-02-18
  • 通信作者: 樊尚荣

Pregnancy complicated with IgG4-related thyroid disease: a case report and literature review

Qianwen Cui1, Yanlan Wang1, Qing Li1, Pingyue Zhao1, Yifei Xu1, Zhidong Yuan1, Wei Han1, Xiaowei Zhang1, Lei Huang1, Shangrong Fan1,()   

  1. 1. Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China
  • Received:2023-11-07 Published:2024-02-18
  • Corresponding author: Shangrong Fan
引用本文:

崔骞文, 汪燕兰, 李晴, 赵平月, 徐一菲, 袁知东, 韩巍, 张笑薇, 黄磊, 樊尚荣. IgG4相关甲状腺疾病合并妊娠一例并文献复习[J/OL]. 中华产科急救电子杂志, 2024, 13(01): 33-40.

Qianwen Cui, Yanlan Wang, Qing Li, Pingyue Zhao, Yifei Xu, Zhidong Yuan, Wei Han, Xiaowei Zhang, Lei Huang, Shangrong Fan. Pregnancy complicated with IgG4-related thyroid disease: a case report and literature review[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(01): 33-40.

目的

总结分析IgG4相关性疾病(immunoglobulin-G4 related disease,IgG4-RD)的妊娠及产后临床资料、诊治过程及随访结果,以提高产科医生对IgG4-RD的认识水平。

方法

采用回顾性研究方法对2023年1月18日北京大学深圳医院收治的1例(本例患者)IgG4相关甲状腺疾病成功妊娠的诊疗经过,以及通过数据库检索与妊娠相关的IgG4-RD病例报道进行分析。

结果

本例患者29岁,发现甲亢4年余、IgG4-RD 7个月、双胎妊娠,孕29周时因"甲亢危象、心功能Ⅳ级、IgG4-RD、子痫前期、新型冠状病毒感染等"于我院经多学科共同诊治,获得良好围产结局。文献检索到IgG4-RD合并妊娠病例报道6篇(共5例患者),包括本例患者在内的6例患者受累器官、临床表现不尽相同,经激素规范治疗后均获得良好围产结局。

结论

妊娠相关的IgG4-RD表现复杂多样,严重者可致重要脏器功能障碍。IgG4相关甲状腺疾病女性能够成功妊娠但存在较大风险,孕期及产后需持续激素维持治疗、多学科严密监测。

Objective

This study is a case report of a patient with immunoglobulin-G4 related disease (IgG4-RD) associated with pregnancy. It aims to provide a comprehensive analysis of the patient′s clinical data, diagnosis, treatment, and follow-up outcomes, to enhance awareness among obstetricians regarding the significance of IgG4-RD.

Methods

A retrospective analysis was conducted on a patient with pregnancy complicated by IgG4-RD, who was admitted to Peking University Shenzhen Hospital on January 18, 2023. A thorough literature search was performed on pregnancy-related IgG4-RD case reports in the web databases.

Results

A 29-year-old patient with hyperthyroidism for 4+ years and IgG4-RD for 7 months was admitted to our hospital with twin pregnancy at 29 weeks of gestation due to hyperthyroidism crisis, grade IV cardiac function, IgG4-related disease, preeclampsia, and novel coronavirus pneumonia virus infection. A multidisciplinary consultation treatment was taken on her and achieved good perinatal outcomes. A total of six (including current case) case reports regarding pregnancy with IgG4-RD were identified, which exhibited varying symptoms, affected organs, and clinical presentations. All cases showed symptom improvement after receiving standardized hormone treatment.

Conclusions

IgG4-RD related manifestations during pregnancy are intricate, potentially impacting vital organ function. Women with IgG4-related thyroid disease can achieve successful pregnancy, but there is a high risk of pregnancy. Continuous hormone maintenance therapy and multidisciplinary close monitoring are needed during and after pregnancy.

图1 本例患者甲状腺超声、垂体磁共振成像、胸片改变。A:甲状腺超声显示甲状腺增大、形态饱满,腺体回声偏低;B:彩色多普勒超声血流显像:甲状腺双侧叶及峡部内血流信号异常丰富,呈"火海征",提示甲状腺亢进声像;C、D:垂体磁共振成像提示腺垂体内见小囊状长T1长T2信号影,信号均匀边清,大小约3 mm×2 mm,箭头指向腺垂体小囊性灶;E:胸片提示双肺纹理稍显增多、增粗,双肺散在少许斑片影,心影明显增大,左侧膈面及肋膈角模糊,双肺少许渗出病变,左侧胸腔少量积液可能
图2 IgG4相关甲状腺疾病患者(本例患者)血清IgG4变化
图3 IgG4相关甲状腺疾病患者(本例患者)甲状腺功能情况注:TSH:(thyroid stimulating hormone)促甲状腺激素;FT4:(free thyroxine)游离甲状腺素
表1 6例IgG4-RD患者妊娠和产后的临床特征、主要诊断及实验室检查情况
表2 6例IgG4-RD患者妊娠和产后的影像学及病理学检查结果
表3 6例IgG4-RD患者妊娠和产后的主要治疗、围产结局及随访情况
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