回顾性研究：甲状腺机能亢进症伴肝功能损害危险因素分析  

A retrospective study：analyzing the risk factors of liver dysfunction in Graves’ disease

作　　者：李承霞[1] 谭建[1] 张桂芝[1] 孟召伟[1] 王仁飞[1] 李玮[1] 郑薇[1] 

机构地区：[1]天津医科大学总医院核医学科,300052

出　　处：《中华内分泌代谢杂志》2015年第6期501-505,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金（81301244,81171372）;天津市应用基础及前沿技术研究计划（12JCZDJC26000）

摘　　要：目的：肝功能损害是甲状腺机能亢进症（主要是 Graves 病）常见的并发症之一,会直接影响Graves 病治疗方法的选择,以及 Graves 病的治愈率。我们的研究目的是根据 Graves 病患者的临床表现及生化实验室化验结果,分析导致 Graves 病肝功能损害的危险因素。方法2008年至2012年期间初次接受131 I 治疗的1928例 Graves 病患者。在131 I 治疗前进行的各项检查包括：甲状腺24 h 吸碘率（24 h RAIU）、血清 FT3、FT4,血清超敏促甲状腺素（sTSH）,促甲状腺素受体抗体（TRAb）,甲状腺球蛋白抗体（TgAb）,甲状腺过氧化物酶抗体（TPOAb）,血清肝功能检测等。数据分析采用独立样本 t 检验,χ2检验,Logistic 回归和皮尔森相关分析。结果 Graves 病伴发肝功能损害组的患者年龄、Graves 病病程,甲状腺重量,FT4水平, TPOAb 和 TRAb 水平高于单纯 Graves 病组。 Graves 病伴发肝功能损害的影响因素包括：患者年龄、Graves病病程、心率、甲状腺重量、FT4水平,24 h RAIU,TgAb,TPOAb 和 TRAb 水平；其中24 h 吸碘率为保护性因素,而患者年龄、Graves 病病程、心率、甲状腺重量、FT4水平,TgAb,TPOAb 和 TRAb 水平等为 Graves 病伴发肝功能损害的危险因素。结论当 Graves 病患者的年龄超过45岁,心率超过90次/ min,甲状腺的重量〉35 g,Graves 病病程〉3年,FT4〉70.5 pmol/ L,TPOAb〉360 IU/ ml,TRAb〉15 IU/ L 时,Graves 病患者伴发肝功能损害的危险性增加,建议将131 I 治疗为该类患者的首选治疗方法。Objective Liver dysfunction is a common complication of hyperthyroidism [ mainly Graves’ disease（GD）], that may restrict the choice as well as affect the ultimate outcome of treatment. The purpose of this study was to describe the clinical and biochemical patterns in patients suffering from Graves’ disease and liver dysfunction and to determine influential factors. Methods A total of 1 928 patients received radioactive iodine, 131 I treatment. Before 131 I therapy, 24 h radioactive iodine uptake of thyroid（24 h RAIU）, serum free triiodothyronine （FT3 ）, free thyroxine（ FT4 ）, sensitive thyroid-stimulating hormone（ sTSH）, anti-thyrotrophin receptor antibody （TRAb）, thyroglobulin antibody（TgAb）, anti-thyroid peroxidase antibody（TPOAb）, and serum hepatic function parameters etc were performed. Data were analyzed by the unpaired t-test, the independent samples t-test, the χ2 test, logistic regression, and Pearson bivariate correlation. Results Ages, the course of Graves’ disease, the weight of thyroid, FT4 , TPOAb, and TRAb in Graves’ disease patients complicated with liver dysfunction were higher than those in patients with normal hepatic function, as shown in table 1. The influential factors including age, course of Graves’ disease, heart rate, weight of thyroid, FT4, 24 h RAIU, TgAb, TPOAb, and TRAb. 24 h RAIU were the protecting factors. Age, course of Graves’ disease, heart rate, weight of thyroid, FT4 , TRAb, and TPOAb were the risk factors. Conclusion The risk of liver dysfunction in patients with Graves’ disease was increased in the following cases： age over 45 years, heart rate above 90 bpm, weight of thyroid more than 35 g, course of Graves’ disease longer than 3 years, FT4 greater than 70. 5 pmol/ L, TPOAb above 360 IU/ ml, and TRAb above 15 IU/ L. In these coses 131 I therapy will be recommended.

关 键 词：甲状腺机能亢进症 肝功能损害 放射性131 I 治疗 转氨酶 胆红素 危险因素 

分 类 号：R581.1[医药卫生—内分泌]