甲状腺功能亢进症并发肝损害病人的临床分析  

CLINICAL ANALYSIS OF PATIENTS WITH HYPERTHYROIDISM COMPLICATED BY LIVER IMPAIRMENT

作　　者：王永艳[1] 阎胜利[1] 贾兆通[1] 王颜刚[1] 殷静[1] 王冲[1] 

机构地区：[1]青岛大学医学院附属医院内分泌科,山东青岛266003

出　　处：《青岛大学医学院学报》2012年第1期23-26,共4页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨甲状腺功能亢进(简称甲亢)并发肝损害病人的临床特点和相关影响因素。方法回顾性分析2005年9月—2010年9月在我院住院的164例甲亢病人(单纯性甲亢75例、甲亢并发肝损害89例)的成因构成、临床特点和相关因素。结果甲亢并发肝损害发生率为54%,以甲亢性肝损害最常见。所有甲亢并发肝损害病人以肝细胞型肝损害为主,最常见的肝功能异常指标为谷丙转氨酶(ALT),多表现为亚临床性。抗甲状腺药物(ATD)致肝损害ALT升高最为明显,黄疸型肝损害发生率最高,甲巯咪唑(MMI)导致的肝损害最常见。Lo-gistic回归分析显示FT4是甲亢并发肝损害的独立危险因素。甲亢性肝损害以治疗甲亢为主辅以保肝治疗,预后一般较好。15例ATD致肝损害病人10例停用ATD,保肝治疗后行131I治疗。结论甲亢易并发肝损害,FT4是甲亢并发肝损害的危险因素,控制甲亢辅以保肝治疗后绝大部分肝损害可恢复正常,ATD导致肝损害病人多需131I治疗。Objective To investigate the clinical features and related factors of patients with hyperthyroidism（HT） complicated by liver impairment.Methods A retrospective analysis was performed in 164 patients with HT,hospitalized during September 2005-September 2010.Of those,75 were simple HT and 89 complicating liver impairment.Results The incidence of HT with impairment of liver accounted for 54%,mostly hyperthyroid liver impairment,all of which were mainly hepatocellular damage.The most commonly seen was abnormal alanine transarninase（ALT）,manifesting as sub-clinical.Antithyroid drug caused significant elevation of ALT and highest incidence of icteric hepatic lesion.Liver impairment caused by thiamazole was the most frequently seen.Logistic regression analysis showed FT4 was an independent risk factor for liver impairment.For the treatment of hyperthyroid liver impairment,aiming at hyperthyroid combined with hepatoprotection would get a better prognosis.In 15 patients with liver impairment due to antithyroid drug,10 patients underwent 131I therapy after stop taking the drug and received hepatoprotection treatment.Conclusion Patients with HT are susceptible to liver impairment.FT4 is an independent risk factor for this condition.After controlling HT combined with adjunctive therapy of hepoprotection,most of damaged liver function may return to normal.Majority of HT patients with antithyroid-drug-induced hepatic lesion need 131I therapy.

关 键 词：甲状腺功能亢进症 肝损害 抗甲状腺药 

分 类 号：R581.1[医药卫生—内分泌]