摘要
目的 探讨丙硫氧嘧啶 (PTU)治疗甲状腺功能亢进症 (甲亢 )过程中导致症状性肝损伤的临床特点及相关因素。方法 对PTU导致症状性肝损伤的临床及实验室特征、肝损伤恢复特点和相关因素进行回顾性分析。结果 PTU导致症状性肝损伤 12例 ,占同期因甲亢住院患者的 1 3%(12 /914 ) ,男 1例 ,女 11例 ,年龄 (30± 9)岁 ,肝损伤出现在服药后 (36± 18)d ,临床表现为腹胀、乏力、恶心、尿色黄等 ,肝功异常的峰值分别为 :ALT (5 31 7± 35 2 0 ) 11314 2 5U/L、血清碱性磷酸酶 (183±97) 84 35 4U/L、总胆红素 [(中位数 )范围 ]6 7 6 (17 15 6 7 7) μmol/L、直接胆红素 4 7 9(5 6 2 71 0 ) μmol/L ;损伤类型中肝细胞性占 6 6 7%、混合性占 2 5 0 %、胆汁淤积性占 8 3% ,肝损伤时PTU服用剂量为15 0～ 30 0mg/d ;停用PTU及治疗后 ,肝功能恢复正常时间 14～ 14 0d。症状性肝损伤、亚临床性肝损伤和无肝损伤 3组比较 ,既往有抗甲状腺药不良反应史者 ,损伤组显著多于无肝损伤发生组 ,PTU的起始剂量也显著低于无肝损伤组 ,治疗前ALT异常者亚临床性肝损伤组显著高于其他 2组。结论 PTU引起症状性肝损伤多发生于治疗初始阶段 ,以肝细胞性肝损伤多见 ,临床过程相对良性 ,停药、保肝和糖皮质激素治疗后 。
Objective To study the clinical characteristics and factors of symptomatic propylthiouracil (PTU) -induced hepatic injury in patients with hyperthyroidism. Methods A retrospective study of the patients diagnosed with symptomatic PTU-induced hepatic injury,admitted to Peking Union Medical College(PUMC) Hospital from January 1993 to December 2002,were carried out with regard to clinical characteristics,laboratory findings and management. In addition,a comparative study was carried out in hyperthyroidism with symptomatic ,asymptomatic and without PTU-induced hepatic injury at the same time. Symptomatic PTU induced hepatic injury was defined as the development of hepatitis symptoms or jaundice with at least 3-times elevation of liver function test without other causes. Results Nine hundred fourteen patients were admitted to PUMC Hospital from January 1993 to December 2002. Clinically overt symptomatic hepatic injury developed in twelve patients [1.3%,age (30±9) yr,male : female ratio,1∶11] between 7 and 77days after PTU administration. Abdominal distention and fatigue developed in all patients. Serum level of ALT and total bilirubin (TBil) increased to (531.7±352.0) 113-1425 U/L and 67.6 (17.1-567.7) μmol/L,respectively. Prothrombin time prolonged in three cases and plasma ammonia elevated in one case. The types of hepatic injury were hepatocellular in eight,cholestatic in one and mixed in two. None resulted from viral hepatitis and autoimmune hepatitis. There was significant difference in history of side effects of antithyroid agents,PTU dose and abnormal ratio of serum ALT among patients with symptomatic,asymptomatic and without hepatic injury (P<0.05). However,there were no statistic differences in age, sex,serum levels of T_4,T_3,and increased thyroglobulin antibody,thyroid peroxidase antibody and thyrotrophin receptor antibody at initial diagnosis. The liver function test normalized in all patients from 14 to 140 days after the PTU withdrawal. Conclusions Symptomatic hepatic injury usually develops with PTU administration in the first few months,though it is unusual. It may be difficult to predict its development and the patient should be monitored for the liver function in the early stage of PTU administration.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2004年第6期442-446,共5页
Chinese Journal of Internal Medicine
