原发性胆汁性胆管炎患者血清甲状腺激素水平和抗甲状腺抗体阳性率变化  

Changes of serum thyroid hormone levels andprevalence of anti-thyroid antibodies in patients with primary biliary cholangitis

作　　者：周晓永[1] 白阳秋[1] 杨惠[1] 张炳勇[1] 曲波[2] Zhou Xiaoyong;Bai Yangqiu;Yang Hui(Department of Gastroenterology,Provincial People's Hospital,Affiliated to Zhengzhou University,Zhengzhou 450003,Henan Province,China)

机构地区：[1]河南省人民医院消化内科,郑州市450003 [2]哈尔滨医科大学附属第二医院消化内科

出　　处：《实用肝脏病杂志》2022年第1期46-49,共4页Journal of Practical Hepatology

摘　　要：目的探讨原发性胆汁性胆管炎(PBC)患者血清甲状腺激素水平和抗甲状腺抗体阳性率变化。方法2018年1月~2020年1月我院收治的PBC患者94例,其中肝硬化50例(Child-Pugh A级29例,B级15例,C级6例)和胆管炎44例,另选择同期于我院健康体检者60名,采用化学发光免疫法测定血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平及血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)。结果胆管炎患者血清FT3、FT4和TSH水平分别为(2.4±0.5)ng/L、(1.4±0.2)ng/L和(8.9±2.3)ng/L,血清TPOAb和TGAb阳性率分别为77.3%和81.8%,肝硬化患者血清FT3、FT4和TSH水平分别为(1.9±0.3)ng/L、(1.0±0.1)ng/L和(19.7±4.9)ng/L,血清和TPOAb和TGAb阳性率分别为70.0%和64.0%,而健康人血清FT3、FT4和TSH水平分别为(2.8±0.8)ng/L、(1.8±0.3)ng/L和(3.4±1.2)ng/L,血清TPOAb和TGAb阳性率均为0.0%,肝硬化和胆管炎患者血清FT3和FT4水平显著低于,血清TSH水平显著高于健康人(P<0.05),而肝硬化患者血清FT3和FT4水平显著低于,血清TSH水平显著高于胆管炎患者(P<0.05),肝硬化和胆管炎患者血清TPOAb和TGAb阳性率比较,无统计学差异(P>0.05);在肝硬化患者中,Child-Pugh A级患者血清FT3和FT4水平显著高于,血清TSH水平显著低于Child-Pugh B级或C级患者(P<0.05),而Child-Pugh B级患者血清FT3和FT4水平显著高于,血清TSH水平显著低于Child-Pugh C级患者(P<0.05),不同肝功能分级的肝硬化患者血清TPOAb和TGAb阳性率比较,无统计学差异(P>0.05)。结论原发性胆汁性肝硬化和胆管炎患者血清FT3、FT4和TSH水平显著不同于健康人,血清TPOAb和TGAb阳性率较高,其临床意义值得进一步观察和研究。Objective The paper aimed to investigate the changes of serum thyroid hormone levels and serum positive rate of anti-thyroid antibody in patients with primary biliary cholangitis(PBC).Methods A total of 94 patients with PBC including 50 cases of cirrhosis(Child-Pugh class A in 29 cases,class B in 15 cases,and class C in 6 cases)and 44 cases of cholangitis were enrolled in our hospital between January 2018 and January 2020,and another 60 healthy volunteers in physical examination in our hospital during the same period were included for control in the study.5 mL of peripheral venous blood under the morning fasting state was taken to determine serum free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(thyroid stimulating hormone,TSH)by chemiluminescence immunoassay,and thyroid peroxidase antibody(TPOAB)and thyroglobulin antibody(TGAB)were assayed.Results Serum levels of FT3,FT4 and TSH in patients with cholangitis were(2.4±0.5)ng/L,(1.4±0.2)ng/L and(8.9±2.3)ng/L,and serum positive rates of TPOAb and TGAb were 77.3%and 81.8%,serum levels of FT3,FT4 and TSH in patients with liver cirrhosis were(1.9±0.3)ng/L,(1.0±0.1)ng/L and(19.7±4.9)ng/L,and serum positive rates of TPOAb and TGAb were 70.0%and 64.0%,while serum levels of FT3,FT4 and TSH in healthy subjects were(2.8±0.8)ng/L,(1.8±0.3)ng/L and(3.4±1.2)ng/L,and serum positive rates of TPOAb and TgAb were 0.0%and 0.0%,respectively,suggesting serum FT3 and FT4 levels in patients with cirrhosis and cholangitis significantly lower,serum TSH level was significantly higher than those in healthy persons(P<0.05),while serum FT3 and FT4 levels in patients with cirrhosis were significantly lower,serum TSH level was significantly higher than those in patients with cholangitis(P<0.05);there was no significant difference in the positive rates of TPOAb and TgAb between patients with liver cirrhosis and with cholangitis(P>0.05);serum levels of FT3,FT4 and TSH in cirrhotics with Child-Pugh class A were(2.2±0.4)ng/L,(1.2±0.2)ng/L and(12.2±2.8)ng/L,serum

关 键 词：原发性胆汁性胆管炎 肝硬化 甲状腺激素 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 

分 类 号：R575.7[医药卫生—消化系统]