1221例未治疗成年 Graves 病患者肝功能指标异常情况及相关因素分析  

Analysis of liver dysfunction parameters and its associated factors in 1 221 untreated adult patients with Graves’ disease

作　　者：刘然[1] 杨倩琳 赵丽 王津京[1] 郑丹[1] 曾静[1] 方毅[1] 

机构地区：[1]解放军307医院内分泌科,北京100071 [2]解放军307医院检验科,北京100071 [3]宿迁市第一人民医院内分泌科,223800

出　　处：《中华内分泌代谢杂志》2015年第6期497-500,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的：调查中国未治疗成年 Graves 病患者转氨酶、胆红素等肝功能指标变化情况,并分析其相关因素。方法收集解放军307医院2006年1月至2014年8月之间门诊及住院新诊断或复发后未经治疗的成年 Graves 病患者,完善肝功能、甲状腺功能、甲状腺抗体等检验,肝功能异常者完善甲肝、乙肝、丙肝抗原抗体检验。分析 Graves 病患者肝功能变化情况,及其与甲状腺功能、甲状腺抗体的相关性。结果符合条件的患者共1254例,排除新发现的病毒性肝炎患者33例,最终入选患者1221例,男性347例,女性874例,平均年龄（39.3±9.5）岁。根据肝功能情况分为肝功能异常组（616例）和肝功能正常组（605例）。肝功能异常组平均年龄大于正常组[（40.1±9.2对38.5±8.7）岁,P〈0.05],女性比例更高（81.8%对61.2%,P〈0.05）。部分患者的甲状腺功能以及甲状腺抗体至少1项大于仪器检验范围上限而具体数值无法测出,肝功能异常组中此类患者更为多见。甲状腺功能测不出组丙氨酸转氨酶[ALT,（37.69±7.51对31.90±5.95）U/ L,P〈0.05]、门冬氨酸氨基转移酶[AST,（31.97±5.09对27.88±3.82） U/ L,P〈0.05]、直接胆红素[DBiL,（5.58±0.77对4.54±0.71）μmol/ L,P〈0.05]均高于甲状腺功能可测出组。在所有指标可测出的患者中,肝功能异常组三碘甲酰原氨酸[T3,（5.42±0.29对4.94±0.33） nmol/ L,P〈0.05]、甲状腺素[T4,（217.53±14.32对204.22±13.54） nmol/ L,P〈0.05]、游离三碘甲酰原氨酸[FT3,（15.88±2.86对14.48±4.83） pmol/ L,P〈0.05]、游离甲状腺素[FT4,（48.91±8.45对42.95±6.14） pmol/ L,P〈0.05]、甲状腺过氧化物酶抗体[TPOAb,（402.75±89.99对210.70±44.63） IU/ ml,P〈0.05]以及促甲状腺素受体抗体[TRAb,（14.08±5.24对9.04±2.58） IU/ L,P〈0.05]均高于肝功能正常者。经多因素 logistic 回归分析发现年龄（OR=0.98,95% CI 0.97~0.99）、性别（OR =0.94,95% CI 0.91~0.97）、FT4（OR =3.08Objective To investigate the trend of liver function changes in untreated adult patients with Graves’ disease in China, and to analyze the associated factors. Methods Patients with newly diagnosed as well as recurrent Graves’ disease from January 2006 to August 2014 were enrolled. They were over 18 years old and did not receive any treatments, Examination of liver function, thyroid function, and thyroid related antibodies as well as tests regarding virus hepatitis were performed. Results A total of 1 254 patients were enrolled. 33 patients with virus hepatitis were ruled out. Ultimately, 1 221 patients matched the criteria of our trial, with 347 males and 874 females [（39. 3 ± 9. 5） year old]. After inclusion, they were assigned to 2 groups according to their liver function results（605 in normal group and 616 in abnormal group）. Compared to normal group, patients in the abnormal group were older [（40. 1 ± 9. 2 vs 38. 5 ± 8. 7） year old, P〈0. 05] and with higher proportion of females（81. 8% vs 61. 2% , P〈0. 05）. Regarding the thyroid function and related antibody tests, some patients yielded results that were extremely high so as to exceed the upper limit of the normal range. These patients were more frequently seen in the group with abnormal liver function. The patients whose thyroid function parameters exceeded the upper limit had higher level of alanine aminotransferase[ALT,（37. 69 ± 7. 51 vs 31. 90 ± 5. 95） U/ L, P〈0. 05], aspartate aminotransferase[AST,＆nbsp;（31. 97 ± 5. 09 vs 27. 88 ± 3. 82） U/ L, P〈0. 05], direct bilirubin[DBiL, （5. 58 ± 0. 77 vs 4. 54 ± 0. 71） μmol/ L, P〈0. 05]than the group whose thyroid function on the detected range. In the patients with all results detected, patients in abnormal liver function group had higher level of triiodthyronine[T3 , （5. 42 ± 0. 29 vs 4. 94 ± 0. 33） nmol/ L, P〈0. 05], thyroxin[T4 ,（217. 53 ±14. 32 vs 204. 22 ±13. 54） nmol/ L, P〈0. 05], free triiodthyronine[FT3 ,（15. 88 ± 2. 86 vs 14. 48 ±4.

关 键 词：格雷夫斯病 肝功能 甲状腺功能 甲状腺相关抗体 

分 类 号：R581.1[医药卫生—内分泌]