非酒精性脂肪性肝病患者甲状腺激素水平变化及其临床意义

目的探讨非酒精性脂肪性肝病（NAFLD）患者血清甲状腺激素水平变化及其临床意义。方法采用放射免疫法检测123例NAFLD患者及56例对照组的血清甲状腺激素（TT3、TT4、TSH）及透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原氨基末端肽（PⅢNP）、Ⅳ型胶原（CⅣ）等反映肝纤维化的血清学指标。结果 非酒精性脂肪性肝炎（NASH）组血清TT3浓度低于对照组及非酒精性单纯性脂肪肝（NASFL）组（P〈0.05）;三组间血清TT4、TSH浓度比较无显著差异（P〉0.05）;NASFL组患者血清HA、PⅢNP浓度高于对照组（P〈0.05）,CⅣ、LN浓度与对照组比较无显著差异（P〉0.05）;NASH组血清HA、PⅢNP、CⅣ、LN浓度均高于对照组及NASFL组（P〈0.05）;中、重脂肪肝组TT3浓度低于对照组（P〈0.05）,HA、PⅢNP、CⅣ、LN浓度高于对照组（P〈0.05）;轻度脂肪肝组TT3、HA、PⅢNP、CⅣ、LN浓度与对照组比较无显著差异（P〉0.05）。NASFL患者血清TT3水平与HA、PⅢNP呈负相关（P〈0.05）;NASH组患者血清TT3水平与HA、PⅢNP、CⅣ、LN均呈负相关（P〈0.05）。结论 NAFLD患者存在血清TT3水平降低,且下降程度与临床分型、超声分度及肝纤维化严重程度一致,检测NAFLD患者血清TT3浓度变化对判断病情及预后有一定的临床意义。

Levels and clinical significance of thyroid hormones in non-alcoholic fatty liver disease patients

Objective To explore the change and clinical significance of serum levels of thyroid hormones in patients with non-alcoholic fatty liver disease（NAFLD）. Methods The blood samples were collected from 123 NAFLD patients and 56 normal controls.Then the assays of not only thyroid hormone,including 3,5,3,5,-tetraiodothyronine（TT₄）,3,3,5,-triiodothyronine（TT₃） and thyroid stimulating hormone（TSH）,but also serum markers of hepatic fibrosis,such as hyaluronic acid（HA）,laminin（LN）,amino terminal procollagen type Ⅲ peptide（PⅢNP） and collagen type IV（CIV） were detected by radioimmunoassay. Results The serum concentration of TT₃ was significantly lower in NASH group than that in control group and NASFL group（P<0.05）;there was no significant difference in the serum levels of TT₄ and TSH among three groups（P>0.05）.The serum levels of HA and PⅢNP were much higher in NASFL group than those in control group（P<0.05）,but there was no significant difference in the serum levels of CⅣ and LN between the two groups（P>0.05）.In addition,the serum levels of HA,PⅢNP,CⅣ and LN increased significantly in NASH group compared with control group and NASFL group（P<0.05）.The serum concentration of TT₃ was significantly lower in the moderate and severe fatty livers group than that in control group（P<0.05）;by contrast,the serum concentrations of HA,PⅢNP,CⅣand LN were significantly higher in the moderate and severe fatty livers group than those in control group.There was no significant difference in the serum levels of TT₃,HA,PⅢNP,CⅣand LN between the mild fatty livers group and control group（P>0.05）.Thus,these results showed that the serum level of TT₃ was negatively correlated with the serum levels of HA and PⅢNP in NASFL group（P<0.05） and the serum levels of HA,PⅢNP,CⅣand LN in NASH group（P<0.05）. Conclusion There is a decreasing serum level of TT₃,and its decreasing degree is consistent with the clinical patterns,severity and hepatic fibrosis in NAFLD patients.Detecting the serum level of TT₃ has some clinical value for the judgment of the severity and hepatic fibrosis as well as prognosis of NAFLD patients.