甲状腺功能亢进症合并肝损伤患者的临床特点分析  

Analysis of clinical characteristics of patients with hyperthyroidism combined with liver injury

作　　者：盛秋菊[1] 丁洋[1] 张翀[1] 韩超[1] 李艳伟[1] 樊耀昕[1] 窦晓光[1] Sheng Qiuju;Ding Yang;Zhang Chong;Han Chao;Li Yanwei;Fan Yaoxin;Dou Xiaoguang(Department of Infectious Diseases,Shengjing Hospital of China Medical University,Shenyang 110022,China)

机构地区：[1]中国医科大学附属盛京医院感染科,沈阳110022

出　　处：《中华肝脏病杂志》2021年第10期967-971,共5页Chinese Journal of Hepatology

基　　金：辽宁省自然科学技术基金指导计划(2019-ZD-0788)。

摘　　要：目的分析甲状腺功能亢进症(简称甲亢)合并肝损伤患者的临床特点,评价患者的甲状腺功能异常及肝损伤特点,探讨肝损伤患者后续抗甲亢治疗模式。方法回顾性分析甲亢合并肝损伤患者的临床资料,根据就诊前是否抗甲亢治疗分为治疗组和未治疗组,分析就诊时患者的甲状腺功能及肝功检测指标,判断发生肝损伤的主要原因;分析治疗组患者肝损伤的特点;给予甲状腺毒性较重的甲亢合并肝损伤患者后续抗甲亢治疗,主要是小剂量甲巯咪唑(MMI)治疗和放射碘治疗,评估其疗效和安全性。数据组间比较采用t检验、秩和检验以及χ^(2)检验。结果43例甲亢合并肝损伤患者中,男性19例,女性24例,年龄(49.0±14.6)岁;40~≤60岁16例(16/43,37.21%),>60岁15例(15/43,34.88%)。就诊时未治疗患者22例(未治疗组,占51.16%),已抗甲亢治疗患者21例(治疗组,占48.84%),两组患者的甲状腺功能指标(游离三碘甲状腺素、游离甲状腺素T4、促甲状腺素)和肝功能指标(丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、γ-谷氨酰转移酶、总胆红素)比较,差异均无统计学意义(P>0.05)。不同治疗方案的患者肝损伤从轻到重的顺序为:MMI<丙基硫氧嘧啶<放射碘<传统中草药。小剂量MMI用于不同程度肝损伤患者抗甲亢治疗均安全有效。结论甲亢合并肝损伤患者发病与年龄相关,主要原因是甲状腺毒性造成。小剂量MMI用于不同程度肝损伤患者抗甲亢治疗安全有效。Objective To analyze,explore and evaluate the clinical characteristics,abnormal thyroid function and follow-up of anti-hyperthyroidism treatment mode in patients with hyperthyroidism(commonly abbreviated as HT)combined with liver injury.Methods The clinical data of patients with hyperthyroidism combined with liver injury were retrospectively analyzed,and then patients were divided into treated and untreated group according to whether they received anti-hyperthyroidism treatment before the consultation.Patients’thyroid and liver function test indicators at the time of treatment were analyzed to determine the main cause of liver injury.The characteristics of liver injury were analyzed in the treatment group.Patients with severe thyroid toxicity and hyperthyroidism combined with liver injury were followed-up with anti-hyperthyroid therapy,mainly low-dose methimazole(MM1)and radioactive iodine therapy to evaluate its efficacy and safety.The comparison between data groups was performed by t-test,rank sum test and χ^(2) test.Results Among the 43 cases with hyperthyroidism combined with liver injury,19 were males and 24 were females,aged 49.0±14.6 years-old;16 cases(16/43,37.21%)aged 40 to≤60 years-old,and 15 cases(15/43,34.88%)aged>60 years-old.There were 22 untreated cases(untreated group,accounting for 51.16%),and 21 treated cases with anti-hyperthyroidism(treatment group,accounting for 48.84%)at the time of consultation.Thyroid function indicators(FT3,FT4,TSH)and liver function indicators(alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,y-glutamyltransferase,total bilirubin)of the two groups were compared,and the difference was not statistically significant(P>0.05).The order of liver injury from mild to severe in patients with different treatment options were:methimazole(MMI)<propylthiouracil<radioactive iodine ctraditional Chinese herbal medicine.Low-dose MMI was safe and effective in patients with different degrees of liver injury with antihyperthyroidism treatment.Conclusion The inci

关 键 词：甲状腺功能亢进症 抗甲状腺药物 肝损伤 治疗 

分 类 号：R581.1[医药卫生—内分泌] R575[医药卫生—内科学]