甲状腺功能亢进症合并肝衰竭的临诊应对  

Clinical management of hyperthyroidism complicated with liver failure

作　　者：冯晓云[1] 吴景竹 赵立[1] 吴艺捷[1] 彭永德[1] 刘芳 王育璠[1] Feng Xiaoyun;Wu Jingzhu;Zhao Li;Wu Yijie;Peng Yongde;Liu Fang;Wang Yufan(Department of Endocrinology and Metabolism,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]上海交通大学医学院附属第一人民医院内分泌科,200080

出　　处：《中华内分泌代谢杂志》2023年第7期611-615,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市自然科学基金项目(20ZR1444400)。

摘　　要：本研究收集了既往诊治的11例甲状腺功能亢进症(甲亢)合并肝衰竭患者的临床资料, 其中4例为药物性肝炎引起的肝衰竭, 1例为血吸虫性肝硬化病史合并甲亢, 6例为甲状腺毒症相关性肝损伤(hyperthyroidism-induced liver injury, HILI)引起的肝衰竭。住院期间所有患者接受基础支持治疗以及β-受体阻滞剂对症治疗, 分别有9例患者接受糖皮质激素和人工肝治疗。11例患者中2例死亡, 8例患者于治疗后1~12个月甲状腺和肝功能恢复正常, 1例肝硬化患者后期肝功能稳定。肝功能改善后7例患者接受同位素治疗, 1例行甲状腺全切手术, 1例接受药物治疗。以上结果表明药物性肝炎及HILI肝衰竭引起的肝功能异常的临床特征并不尽相同, 治疗上应在β-受体阻滞剂和糖皮质激素基础上尽早进行人工肝治疗以缓解甲状腺毒症及肝功能损害, 为后续同位素或手术治疗甲亢创造时机。Clinical data from 11 previously diagnosed and treated patients with hyperthyroidism(Graves′disease)complicated by liver failure were collected.Among them,4 cases were drug-induced liver injury leading to liver failure,1 case had a history of schistosomal liver cirrhosis combined with hyperthyroidism,and 6 cases had hyperthyroidism-induced liver injury(HILI)leading to liver failure.During hospitalization,all patients received supportive therapy and symptomatic treatment withβ-blockers.Nine patients were treated with glucocorticoids and artificial liver support therapy.Among the 11 patients,2 died,8 patients achieved normal thyroid and liver function within 1-12 months after treatment,and 1 patient with liver cirrhosis had stable liver function in the later stage.After improvement in liver function,7 patients received isotope therapy,1 patient underwent total thyroidectomy,and 1 patient received medication.These results indicate that the clinical characteristics differ for drug-induced liver injury and HILI-related liver failure.Early initiation of artificial liver support therapy,in addition toβ-blockers and glucocorticoids,is important in alleviating thyroid toxicity and liver damage,thus creating an opportunity for subsequent radioactive iodine or surgical treatment.

关 键 词：甲状腺功能亢进 肝衰竭 临床特征 诊治 预后 

分 类 号：R581.1[医药卫生—内分泌] R575.3[医药卫生—内科学]