初诊Graves病患者甲亢性肝损害相关因素研究  

The Study of Liver Dysfunction in Patients with Untreated Hyperthyroidism and Correlated Factors

作　　者：王大斌[1] 江雪[1] 陈燕玲[2] 史育红[1] 

机构地区：[1]成都医学院附属第二医院.核工业四一六医院核医学科,四川成都610051 [2]成都医学院附属第二医院.核工业四一六医院职业病科,四川成都610051

出　　处：《标记免疫分析与临床》2017年第5期538-541,共4页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探讨初诊Graves病患者甲亢性肝损害的影响因素。方法收集2015年1月至12月于核医学科就诊的初诊Graves病患者751例,血清检测甲功、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)和促甲状腺激素受体抗体(thyrotrophin receptor antibody,TRAb)及TBIL、ALT、AST、r-GT、ALP。根据肝功结果分为肝功异常组及肝功正常组,分析患者性别、年龄、病程、TRAb、TPOAb、TGAb、FT_3、FT_4与肝损害的关系。结果 751例初诊Graves病患者中,肝功异常患者508例(67.64%),肝功异常组五项肝功异常指标中以ALP升高的最多,343例(67.52%)。与肝功正常组比较,肝功异常组患者病程长,TBIL、ALT、AST、r-GT、ALP、FT_3、FT_4及TRAb水平升高,差异有统计学意义(P<0.001);而TPOAb、TGAb、性别、年龄差异无统计学意义(P>0.05)。初诊Graves病患者TRAb分别与FT_3(r5_s=0.511)、FT_4(r_s=0.436)呈正相关(P<0.001);FT_3、FT_4、TRAb分别与TBIL(r_s=0.206,r_s=0.202,r_s=0.216)、ALT(r_s=0.217,r_s=0.227,r_s=0.318)、AST(r_s=0.258,r_s=0.190,r_s=0.242)、r-GT(r_s=0.217,r_s=0.224,r_s=0.310)、ALP(r_s=0.343,r_s=0.358,r_s=0.463)呈正相关(P<0.001)。多因素Logistic回归分析发现,仅TRAb的OR值>1.1且差异有统计学意义(OR=1.133,OR 95%CI为1.104~1.164,P<0.001)。结论病程、FT_3、FT_4及TRAb水平与初诊Graves病甲亢性肝损害程度正相关,其中TRAb是其危险因素。Objective To explore the influencing factors of hyperthyroid liver damage in patients with newly diagnosed Graves disease. Methods From January 2015 to December 2015,751 newly diagnosed patients with Graves hyperthyroidism patients were enrolled for study. Serum thyroid function, thyroid peroxidase antibody （ TPOAb）, thyroglobulin antbody （ TGAb ）, thyrotrophin receptor antibody （ TRAb ） levels and liver function （ TBIL, ALT, AST, r- GT, ALP） were measured. According to liver function resutls, the subjects were divided into abnormal liver function group and normal liver function group. The effects of gender, age, duration of disease, TRAb, TPOAb, TGAb, FT3 and FT4 on the liver function were analyzed using correlation analysis and logistic regression analysis. Results 508 patients with abnormal liver function（67.64% ）, especially 343 cases （ up to 67.52 ） with abnormal ALP, TBIL, ALT, AST, r- GT, ALP, FT3 , FT4, TRAb were significant higher in the abnormal liver function group than that of normal liver function group （ P 〈 0. 001 ）, no significant difference was found among gender, age, TPOAb and TGAb （ P 〉 0.05）. TRAb was positively correlated with PT3 （ rs = 0. 511 ） and Fr4 （ rs = 0. 436 ） in newly diagnosed Graves hyperthyroidism patients （ P 〈 0. 001 ）. PT3 ,FT4 and TRAb were positively correlated with TBIL（ rs = 0. 206, rs = 0. 202, rs = 0. 216 ）, ALT（ rs = 0. 217,rs =0. 227,rs =0.318） ,AST（rs=0.258,rs =0. 190,rs=0. 242） ,r-GT（rs =0. 217,rs =0. 224,rs = 0. 310） ,ALP（ rs = 0. 343, rs = 0. 358, rs = 0. 463 ） respectively（ P 〈 0. 001 ）. Logistic regression analysis on the influencing factors analysis showed that the OR values of PT3 , PT4, duration of the disease and TRAb were greater than 1.1, and the OR value of TRAb was significantly higher than the other three influencing factors （OR = 1. 133, OR 95% CI 为 1. 104-1. 164, P 〈 0. 001 ）. Conclusion For patients with newly diagnosed Granes disease, the duration of disease, FT3 ,

关 键 词：GRAVES病 促甲状腺激素受体抗体 肝功能异常 甲状腺激素 

分 类 号：R581.1[医药卫生—内分泌]