激素联合甲巯咪唑治疗甲亢危象伴乙肝肝衰竭1例  

Hormones combined with methimazole in the treatment of thyroid crisis with hepatitis B and liver failure:a case report

作　　者：宋晓钰 李倩 王璐璐 王鑫 董振华 逄曙光[1,2] SONG Xiaoyu;LI Qian;WANG Lulu;WANG Xin;DONG Zhenhua;PANG Shuguang(Shandong University,Jinan 250100,Shandong,China;Department of Endocrinology,Jinan Central Hospital,Shandong First Medical University,Jinan 250013,Shandong,China)

机构地区：[1]山东大学,山东济南250100 [2]山东第一医科大学附属中心医院内分泌科,山东济南250013

出　　处：《山东大学学报（医学版）》2024年第1期76-81,101,共7页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81400788);山东省医药卫生科技发展计划(2019WS076);山东省博士后基金(SDCX-ZG-202202004);济南市临床医学科技创新计划(202328040,201907039)。

摘　　要：目的探讨甲亢合并肝损害患者的治疗方法,特别是当甲状腺危象同时合并乙肝及肝衰竭时,药物有效性及安全性的临床实践依据。方法报道1例甲亢合并未控制的慢乙肝肝衰竭患者,详细描述其治疗过程,包括保肝降酶、人工肝血液净化以及抗病毒治疗,以及在并发甲亢危象后应用糖皮质激素联合甲巯咪唑治疗。结果患者入院时丙氨酸氨基转移酶(alanine aminotransferase,ALT)为534.6 U/L,天门冬氨酸氨基转氨酶(aspartate aminotransferase,AST)为597.3 U/L,国际标准化比值(international normalized ratio,INR)为1.92,凝血酶原活动度(prothrombin activity,PTA)为30.7%。经过保肝降酶、人工肝血液净化治疗后,INR为1.94,PTA为30.1%。此时,患者并发甲亢危象,在抗病毒治疗的同时,使用了糖皮质激素联合甲巯咪唑进行治疗。治疗后,患者的ALT为73.3 U/L,AST为58.2 U/L,INR为1.26,PTA为70.9%。结论对于甲亢导致的肝衰竭,应用甲巯咪唑不是禁忌证,治疗甲亢原发病比保肝对症支持治疗对肝功能的恢复更有力;甲状腺危象合并乙肝和肝衰竭时,在抗乙肝病毒的同时加用糖皮质激素能有效改善甲亢和肝损伤。Objective To explore the clinical basis of drug effectiveness and safety in the treatment of hyperthyroidism complicated with liver damage,especially in cases of thyroid crisis with hepatitis B and liver failure.Methods A case of hepatic failure complicated with hyperthyroidism with uncontrolled chronic hepatitis B was reported.The course of treatment was described,including hepatoprotective,enzyme-lowering treatment,artificial liver blood purification,antiviral therapy,and glucocorticoid combined with methimazole therapy after thyroid crisis.Results At admission,the patient's alanine aminotransferase(ALT)was 534.6 U/L,aspartate aminotransferase(AST)was 597.3 U/L,international normalized ratio(INR)was 1.92,and prothrombin activity(PTA)was 30.7%.After hepatoprotective,enzyme-lowering treatment,the INR was 1.94,and PTA was 30.1%.At this time,thyroid crisis occurred,which was dealt with glucocorticoid and methimazole along with antiviral therapy.After treatment,the ALT was 73.3 U/L,AST was 58.2 U/L,INR was 1.26,and PTA was 70.9%.Conclusion For liver failure caused by hyperthyroidism,the use of methimazole is not contraindicated,since treatment of the primary disease of hyperthyroidism is more effective than supportive treatment of liver protection.In case of thyroid crisis complicated with hepatitis B and liver failure,glucocor ticoid can effectively improve hyperthyroidism and liver injury along with antiviral therapy.

关 键 词：甲状腺功能亢进 甲状腺危象 乙型病毒性肝炎 肝衰竭 甲巯咪唑 

分 类 号：R581.5[医药卫生—内分泌]