摘要
目的探讨肝硬化患者的甲状腺激素水平及其临床意义。方法选取189例肝硬化患者作为肝硬化组,主要类型包括乙型肝炎性肝硬化、酒精性肝硬化、乙型肝炎性合并酒精性肝硬化、自身免疫性肝病引起的肝硬化。同时选择50例健康体检者作为对照组。比较两组的血清促甲状腺素(TSH)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总四碘甲状腺原氨酸(TT4)、游离四碘甲状腺原氨酸(FT4)水平,并分析肝硬化患者Child-Pugh评分及终末期肝病模型(MELD)评分与血清甲状腺激素水平的相关性。结果 (1)肝硬化组TT3、FT3、TT4、FT4水平均低于对照组(均P <0. 05)。(2)常见4种病因肝硬化患者TT3、FT3、TT4水平均低于对照组(均P <0. 05),乙型肝炎性肝硬化患者TSH、FT4水平均低于对照组(均P <0. 05)。(3) Child-Pugh A、B级肝硬化患者FT4水平低于对照组(均P <0. 05)。不同Child-Pugh分级肝硬化患者血清FT3、TT4水平均低于对照组,Child-Pugh B、C级患者血清FT3、TT4水平低于Child-Pugh A级患者(均P <0. 05),且TT3水平低于对照组(P <0. 05)。(4)肝硬化患者MELD评分与TT3、FT3、TT4、TSH呈负相关,与FT4呈正相关(P <0. 05)。Child-Pugh评分与TT3、FT3、TT4呈负相关,与FT4呈正相关(P <0. 05)。结论肝硬化患者的甲状腺功能低下,血清甲状腺激素或可作为判断肝硬化病情程度及评价预后的指标。
Objective To investigate the thyroid hormone level and its clinical significance in the patients with liver cirrhosis.Methods A total of 189 patients with liver cirrhosis were selected as cirrhosis group,including hepatitis B cirrhosis,alcoholic cirrhosis,hepatitis B complicated with alcoholic cirrhosis,and autoimmune hepatitis-induced cirrhosis.Meanwhile,50 healthy check-up people were enrolled as control group.The levels of serum thyroid-stimulating hormone(TSH),total triiodothyronine(TT3),free triiodothyronine(FT3),total tetraiodothyronine(TT 4)and free tetraiodothyronine(FT4)were compared between the two groups.The correlation of Child-Pugh score or Model for End-Stage Liver Disease(MELD)score with serum level of thyroid hormone was analyzed in the patients with liver cirrhosis.Results(1)The levels of TT 3,FT 3,TT 4 and FT 4 in the cirrhosis group were lower than those in the control group(all P<0.05).(2)The levels of TT 3,FT 3 and TT 4 in the patients with the four common etiologies of cirrhosis were lower than those in the control group(all P<0.05),the levels of TSH and FT 4 in the patients with hepatitis B cirrhosis were lower than those in the control group(all P<0.05).(3)The levels of FT 4 in the patients with Child-Pugh A or B cirrhosis were lower than those in the control group(all P<0.05).The levels of serum FT 3 and TT 4 in the patients with various Child-Pugh cirrhosis were lower than those in the control group,the patients with Child-Pugh B or C had lower levels of serum FT 3 and TT 4 compared with the patients with Child-Pugh A(all P<0.05),and had lower TT 3 level compared with the control group(P<0.05).(4)For patients with liver cirrhosis,the MELD score negatively correlated with TT 3,FT 3,TT 4 and TSH,but positively correlated with FT 4(P<0.05).The Child-Pugh score negatively correlated with TT 3,FT 3 and TT 4,but positively correlated with FT 4(P<0.05).Conclusion Thyroid hypofunction is observed in the patients with liver cirrhosis,serum thyroid hormone might serve as an indicator for evaluating the severity and prognosis of liver cirrhosis.
作者
黎增辉
LI Zeng-hui(Department of Infectious Disease,the First Hospital of Changsha,Changsha 410000,China)
出处
《广西医学》
CAS
2018年第24期2917-2920,共4页
Guangxi Medical Journal
