每日一题_2023.07.03

A 32-year-old woman presents to her physician for the third time in six months. She has been feeling very tired and depressed, and has come to talk about starting antidepressants. She also complains of a 4.5-kg (10-lb) weight gain over the past three months. During her physical examination the physician notices that she is wearing a sweater and a coat, despite the room being at a warm temperature. Problems with the thyroid are suspected, and a biopsy is performed (see image). This woman may have a human leukocyte antigen subtype that also increases her risk of which disease?

一名32岁女性在6个月内第三次去看她的医生。她一直感到非常疲惫和抑郁，并开始谈论开始抗抑郁药。她还抱怨在过去的三个月里体重增加了4.5公斤(10磅)。在她的体检中，医生注意到她穿着一件毛衣和一件外套，尽管房间的温度很暖和。怀疑甲状腺有问题，进行活检(见图)。这名妇女可能有人类白细胞抗原亚型，这也增加了她患哪种疾病的风险?

(A) Multiple sclerosis多发性硬化

(B) Pernicious anemia恶性贫血

(C) Psoriasis牛皮癣

(D) Steroid-responsive nephrotic syndrome激素反应性肾病综合征

答案解析：

这名妇女有桥本甲状腺炎的症状，桥本甲状腺炎是一种导致甲状腺功能减退(也称为黏液性水肿)的自身免疫疾病，但在疾病刚发生时，当卵泡破裂时，可能有一过性甲状腺功能亢进。这是一种ⅳ型超敏反应，与甲状腺球蛋白、甲状腺过氧化物酶和促甲状腺激素受体本身的自身抗体相关。桥本甲状腺炎最常见的表现是该患者的症状，以及便秘和皮肤干燥。组织学特征包括大量淋巴细胞浸润伴生殖细胞形成。桥本甲状腺炎与人类白细胞抗原DR5亚型相关，恶性贫血也是如此，恶性贫血是一种由萎缩性胃炎和壁细胞破坏引起的维生素B12缺乏疾病。

正确答案：B