甲状腺功能亢进症患儿393例肝损害相关因素分析  

Hepatic dysfunction in 393 cases of children with hyperthyroidism and its correlative factors

作　　者：马晓丹[1] 毛晓健[1] 刘丽[1] 黄永兰[1] 周志红[1] 李秀珍[1] 程静[1] 黄新疆 盛慧英[1] 

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心遗传与内分泌科,510623

出　　处：《中华实用儿科临床杂志》2015年第8期597-599,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：广州医科大学附属广州市妇女儿童医疗中心博士启动基金（201008）;金赛儿科中青年内分泌医师科研基金（5201-2130108）

摘　　要：目的 探讨甲状腺功能亢进症（甲亢）患儿甲亢性肝损害的发生率及相关因素.方法 将393例甲亢患儿分为甲亢性肝损害组（174例）和甲亢肝功能正常组（219例）,对2组患儿性别、年龄、甲状腺疾病家族史、病程、肝功能及甲状腺功能指标等进行回顾性分析.结果 儿童甲亢性肝损害的发生率为44.3％（174/393例）,甲亢性肝损害最常见的异常指标是丙氨酸氨基转移酶（ALT）升高（147例,占88.5％）.甲亢性肝损害组与甲亢肝功能正常组的性别、年龄、甲状腺疾病家族史、病程、甲状腺过氧化物酶抗体水平、甲状腺球蛋白抗体水平比较差异均无统计学意义（P均＞0.05）;甲亢性肝损害组的游离三碘甲状腺原氨酸水平和游离甲状腺素水平均显著高于甲亢肝功能正常组（Z=-7.90,P=0.000;Z=-8.80,P=0.000）,而促甲状腺激素水平显著低于甲亢肝功能正常组（Z=-4.60,P=0.000）.甲巯咪唑治疗后,甲亢性肝损害组的肝功能与治疗前比较均显著好转：ALT（Z=-14.90,P=0.000）,天冬氨酸转氨酶（Z=-5.30,P=0.000）、γ转肽酶（Z=-5.50,P=0.000）、碱性磷酸酶（Z=-5.90,P=0.000）、总胆红素（Z=-5.50,P=0.000）、结合胆红素（Z=-4.60,P=0.000）、未结合胆红素（Z=-4.60,P=0.000）.结论 儿童甲亢易导致肝损害,甲亢性肝损害与甲状腺激素水平有关;肝损害最常见的异常指标是ALT升高;肝损害通常是短暂的、轻度的;肝功能恢复与甲状腺功能的恢复一致.Objective To explore the morbidity and the related clinical factors of hepatic dysfunction in children with hyperthyroidism.Methods Totally 393 children with hyperthyroidism were divided into 2 groups：hyperthyroidism with hepatic dysfunction group（174 cases） and hyperthyroidism with normal liver function group（219 cases）.The gender,age,family history of thyroid disease,duration of disease,liver function and thyroid function indicators were retrospectively analyzed in the 2 groups.Results The morbidity of hepatic dysfunction in children with hyperthyroidism was 44.3% （174/393 cases）,and the most common abnormal hepatic function parameter was the increase of alanine aminotransferase（ALT）,which accounted for 88.5% （147 cases）.There were no significant differences of gender,age,family history of thyroid disease,duration of the disease,or levels of thyroid peroxidase antibodies and thyroglobulin antibodies between the hepatic dysfunction abnormal group and liver function normal group （all P 〉 0.05）.Free triiodothyronine and free thyroxine of hepatic dysfunction abnormal group were significantly higher than those in liver function normal group （Z =-7.90,P =0.000 ; Z =-8.80,P =0.000） ; and thyroid stimulating hormone of hepatic dysfunction abnormal group was significantly lower than that in liver function normal group （Z =-4.60,P =0.000）.Liver functions after treatment with Methimazole of the hyperthyroidism cases were all significantly improved：ALT（Z =-14.90,P =0.000）,aspartate aminotransterase（Z =-5.30,P =0.000）,γ-glutamyltransferse （Z =-5.50,P =0.000）,alkaline phosphatase （Z =-5.90,P =0.000）,total bilirubin （Z =-5.50,P =0.000）,direct bilirubin （Z =-4.60,P =0.000）,indirect bilirubin （Z =-4.60,P =0.000）.Conclusions Hepatic dysfunction caused by hyperthyroidism in children is common and correlated with thyroid function.Elevation of ALT is the most common abnormal hepatic function parameter.The hepatic dysfunction is usually transient and mild and is to b

关 键 词：儿童 甲状腺功能亢进症 肝损害 甲状腺功能 

分 类 号：R725.8[医药卫生—儿科]