甲状腺功能亢进症重度肝损伤患者的治疗模式  

The treatment mode of hyperthyroid patients with severe liver damage

作　　者：吕飒 朱冰 徐天娇 李东泽 田华 游绍莉 LV Sa;ZHU Bing;XU Tian-jiao;LI Dong-ze;TIAN Hua;YOU Shao-li(Liver Failure Treatment and Research Center,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心肝衰竭诊疗与研究中心,100039

出　　处：《肝脏》2020年第11期1212-1215,共4页Chinese Hepatology

基　　金：北京市科技计划课题资助项目(Z151100004015019)。

摘　　要：目的探讨甲状腺功能亢进症(甲亢)重度肝损伤患者的治疗模式。方法回顾性分析4例甲亢重度肝损伤患者的临床资料及治疗转归。结果4例患者中男性1例,女性3例,年龄29~58岁,既往均未发现甲亢,未使用抗甲状腺药物。其中2例为亚急性肝衰竭,2例合并自身免疫性肝病失代偿期肝硬化,胆红素>10×ULN,ALT、AST、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)不同程度升高。给予β-受体阻滞剂、糖皮质激素,并于血浆置换后进行131 I治疗,患者病情明显好转,亚急性肝衰竭患者分别随访至5个月、3个月肝功完全恢复正常,肝硬化患者病情稳定。结论对甲亢重度肝损伤患者的治疗应以β-受体阻滞剂、个体化的糖皮质激素及人工肝为辅助,及时创造131 I治疗时机,可有效改善肝功能及预后。Objective To explore the treatment mode of hyperthyroidism patients with severe liver damage.Methods The clinical data and treatment outcome of 4 patients with severe hyperthyroidism were analyzed retrospectively.Results Among the 4 patients,1 male and 3 female,aged 29-58 years old,with no hyperthyroidism and no antithyroid drugs have been used.Among them,2 cases were subacute liver failure,2 cases were complicated with decompensated cirrhosis of autoimmune liver disease,TBil was higher than 10×ULN,ALT,AST,ALP and GGT were higher in different degrees.The patients were treated withβ-blocker,glucocorticoid and 131 I after plasma exchange.The patients were followed up for 5 months and 3 months respectively.The liver function of patients with subacute liver failure recovered completely.The patients with cirrhosis were stable.Conclusionβ-blocker,glucocorticoid and artificial liver should be used as adjuvants in the treatment of hyperthyroidism patients with severe liver damage,and 131I treatment opportunity should be created in time,which can effectively improve the liver function and prognosis.

关 键 词：甲亢重度肝损害 糖皮质激素 血浆置换 131 I 治疗 

分 类 号：R581.1[医药卫生—内分泌] R575[医药卫生—内科学]