慢性HBV感染合并甲状腺功能亢进症16例临床分析

目的探讨慢性HBV感染合并甲状腺功能亢进症(甲亢)的临床特点及治疗方法。方法对16例慢性HBV感染合并甲亢患者的临床资料进行回顾性分析。结果 16例慢性HBV感染合并甲亢患者,年龄22~62岁,平均年龄33.5岁,男性5例,女性11例。所有患者均有不同程度的甲亢和肝炎症状,以疲乏、食欲不振为主要临床表现14例,占87.50%;体重明显下降者8例,占50.0%,体重下降范围为3~12kg/w;恶心、呕吐6例,占37.50%;食欲亢进仅1例,占6.25%。甲状腺肿大12例,占75.00%,其中Ⅰ~Ⅱ度肿大7例,占43.75%;ALT升高12例,轻度7例、中度4例、重度1例;胆红素升高11例,多数为轻度升高,最高者为40.97μmol/L。心电图正常9例,占56.25%,窦性心动过速4例,占25.00%。单纯治疗肝炎对甲亢无改善,联合甲亢治疗药物肝功、甲功均得到好转。结论 HBV感染者,体重明显下降,食欲不振程度与肝功能损害程度不平行时,应警惕甲亢存在可能,特别是甲状腺肿大、心率增快者。除综合治疗肝炎外,应积极治疗甲亢,抗甲亢药物和放射性碘-131治疗均可选用。

Clinical analysis of 16 hepatitis B cases complicated with hyperthyroidism

Objective To investigate the clinical features and treatment of hepatitis B cases complicated with hyperthyroidism. Methods Clinical data of 16 hepatitis B cases complicated with hyperthyroidism were retrospectively analyzed. Results The average age of the 16 patients was 33.5 years （22-62 years） including 5 male cases and 11 female eases, all patients had varying degrees symptoms of hepatitis and hyperthyroidism, 14 eases were fatigue and lost apetite inappetence （ 87.00%）, 8 cases exhibited markedly weight loss （50.00%） within the range of 3-12kg / w, 6 eases were with the symptoms of nausea and vomiting （37.50%） and rised bilirubin level was noticed in a case （6.25%）, 12 eases had goiter （75.00%） included 7 eases with Degree I - 11 enlargement （43.75%）, ALT increase occurred to 12 eases including 7 mild eases, 4 moderate eases and 1 severe ease; increase of bilirubin level was detected in 11 eases and most of them were slightly increased and the highest level was 40.97 I~mol / L; the electrocardiograms of 9 cases were normal （56.25%） and tachyeardia was found in 4 cases （25.00%）. The treatment of hepatitis alone could not improve the symptom of hyperthyroidism and treatment of hepatitis B in combination with antithyroid-drug （ATD） could effectively improve liver function and thyroid function. Conclusions Hyperthyroidism, especially goiter, should be considered when significant weight loss and loss of appetite were noticed in hepatitis B cases on condition that the extent of liver damage should be not paralled with loss of appetite. To those with increased heart rate hyperthyroidism be actively treated with antithyroid drugs and radioactive iodine131 with treatment of hepatitis B.