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*

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。

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

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 positive rates of TPOAb and TgAb were 69.0%and 48.3%,serum FT3,FT4 and TSH in patients with Child-Pugh class B were(1.8±0.3)ng/L,(0.9±0.1)ng/L and(16.5±3.3)ng/L,serum positive rates of TPOAb and TGAB were 66.7%and 60.0%,and serum FT3,FT4 and TSH levels in patients with Child-Pugh class C were(1.3±0.1)ng/L,(0.6±0.1)ng/L and(20.7±4.6)ng/L,and serum positive rates of TPOAb and TGAB were 66.7%and 50.0%,respectively,suggesting serum levels of FT3 and FT4 significantly different among them,while serum positive rates of TPOAb and TgAb in cirrhotics were not(P>0.05).Conclusion Serum levels of FT3,FT4 and TSH in patients with cirrhosis and cholangitis change greatly,and serum positive rates of TPOAb and TgAb are significantly high,what it implicate needs further investigation.