肝硬化病人下丘脑-垂体-甲状腺轴的功能变化及临床意义  

Functional changes and clinical significance of hypothalamic-pituitary-thyroid axis in liver cirrhotic patients

作　　者：俞建家[1] 张东军[1] 赵宏[1] 孙志坚[2] 

机构地区：[1]丹阳市人民医院感染科,江苏丹阳212300 [2]南京医科大学第一附属医院感染科,江苏南京210029

出　　处：《安徽医药》2017年第4期664-668,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨不同级别肝硬化(LC)病人下丘脑-垂体-甲状腺轴的变化及临床意义。方法 91例LC病人按Child-Turcotte-Pugh(CTP)计分评级分为三组:LC-A组25例,LC-B组35例,LC-C组31例;另选27名健康人作为对照组。血清总三碘甲状腺原氨酸(TT3)、游离T3(FT3)、反T3(rT3)、总甲状腺素(TT4)、游离甲状腺素(FT4)及促甲状腺激素(TSH)均采用化学发光法检测,肝功能生化指标用RXL生化分析仪检测,凝血酶原时间(PT)用全自动血凝仪(血凝固法)检测。结果从LC-A组到LC-C组随着肝硬化级别的增加,血清TT3和FT3水平逐渐降低,rT3渐次增高,TT4/rT3比值顺次下降,血清TT3分别与白蛋白、前白蛋白、载脂蛋白-A1和胆碱酯酶呈显著正相关(df=89,r值分别为0.568,0.260,0.317和0.599,P<0.05),与CTP分值及PT呈显著负相关(df=89,r值分别为-0.447和-0.297,P<0.01),TSH在各组间差异无统计学意义。共26例LC病人出现低T3综合征,LC-A组为0,LC-B组8例(22.9%),LC-C组18例(58.1%)。经保肝、支持治疗1~2周后,随着肝功能好转低T3综合征也随之消失。心得安试验仅见FT4有所下降(16.84±3.16)vs(14.00±2.45)pmol·L^(-1),地塞米松试验未见甲状腺激素及TSH有明显变化。结论肝硬化失代偿期随着肝功能的下降,发生低T3综合征的比例增多,与甲状腺激素转运蛋白合成功能减退、T4向T3转化减少有关,但随着病情好转低T3综合征便逐渐消失,无须补充甲状腺素。心得安或地塞米松试验对甲状腺功能未产生明显的影响,提示短期适量应用此类药物是安全的。Objective To investigate the functional changes and clinical significance of hypothalamic-pituitary-thyroid axis in liver cir-rhotic patients. Methods A total of 91 cases with HBV related liver cirrhosis （LC） were assigned into three groups： LC-A group （n = 25）, LC-B group （n = 35） and LC-C group （n = 31）, according to Child-Turcotte-Pugh （CTP） score. In addition,27 healthy individu-als served as control group. Serum thyroid hormones, including total triiodothyronine （ TT3 ） ,free T3（FT3） ,revers T3（rT3） , total thy-roxine （TT4） ,free T4（FT4） and thyroid stimulating hormone （TSH） ,were measured with chemiluminescence method; the biochemical markers of liver function were detected by RXL automatic biochemical analyzer, and plasma prothrombin time （ PT） was detected by blood doting method. Results From LC-A to LC-C group, with the exacerbation of liver cirrhosis the serum levels of TT3, FT3 and TT4/rT3 ratio gradually decreased, while serum rT3 gradually increased. Serum TT3 concentrations were positively correlated with those of albumin （ Alb,r =0. 568 〈 0. 01） ,prealbumin （ PA,r =0. 260,P 〈0. 05） ,apolipoprotein-Al （ Apo-Al, r = 0. 317 〈0. 01） and cholinesterase （ CHE,r =0. 599, P 〈 0.01 ） respectively. Conversely, serum TT3 concentrations were negatively correlated with CTP score and PT （r = - 0. 447 and - 0. 297 respectively, P 〈 0 . 01 ,both ） . The serum values of TSH in each group were in the normal range. There were 26 cases with low T3 syndrome,8 of whom occurred in LC-B group （22. 9% ） and 18 in LC-C group （58. 1% ） . After hepatoprotective and supportive therapy for 1-2 weeks,the liver function improved and the thyroid hormones returned to normal. The pro-pranolol test revealed FT4 decrease （16. 84 ±3.16）vs （14. 00 ± 2 .4 5 ） pmol ·L^-1 only, and the dexamethasone test showed no obvi-ous change in thyroid hormones and TSH levels. C

关 键 词：肝硬化 肝功能 甲状腺激素 促甲状腺激素 低T3综合征 

分 类 号：R575.2[医药卫生—消化系统]