熊去氧胆酸治疗原发性胆汁性胆管炎患者血清甲状腺激素水平变化*

目的 探讨应用熊去氧胆酸（UDCA）治疗原发性胆汁性胆管炎患者血清甲状腺激素水平的变化。方法 2016年1月~2017年6月我院治疗的原发性胆汁性胆管炎患者70例和原发性胆汁性肝硬化患者95例,另选20例健康人作为对照组。给予患者UDCA治疗3月,检测治疗前后血清甲状腺激素水平变化。结果 在治疗3个月末,两组患者肝功能指标得到改善,除胆管炎患者血清ALP和GGT水平仍显著高于肝硬化患者外,其他肝功能指标比较,差异无统计学意义（P>0.05）;治疗前,胆管炎患者血清总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）水平分别为1.6±0.2 nmol/L、3.2±0.4 pmol/L、95.6±28.7 nmol/L和10.3±3.6 pmol/L,肝硬化患者分别为1.1±0.2 nmol/L、3.0±0.3 pmol/L、88.2±26.7 nmol/L和9.7±2.5 pmol/L,均显著低于健康人【分别为（2.5±0.5 nmol/L、4.7±0.8 pmol/L、115.7±31.6 nmol/L和13.8±4.1 pmol/L,P<0.05】,两组患者血清促甲状腺素（TSH）水平与健康人比,差异无统计学意义【分别为（2.9±0.5 mIU/L和 2.9±0.7 mIU/L对 3.3±0.6 mIU/L,P>0.05】; 在治疗3个月末,胆管炎患者血清TT3、FT3、TT4和FT4水平分别为2.4±0.6 nmol/L、4.5±0.8 pmol/L、108.2±36.2 nmol/L和12.9±3.5 pmol/L,较治疗前显著上升,已与健康人无统计学差异（P>0.05）,而肝硬化患者血清TT3、FT3、TT4和FT4水平分别为1.2±0.3 nmol/L、3.4±0.4 pmol/L、93.7±29.8 nmol/L和9.9±3.1 pmol/L,无明显改善,仍显著低于健康人（P<0.05）。结论 原发性胆汁性胆管炎患者经熊去氧胆酸治疗后,血清甲状腺激素水平可获得改善,因此应该早期诊断、早期治疗。

Serum thyroid hormone level changes in patients with primary biliary cholangitis receiving ursodeoxycholic acid therapy

Objective To investigate serum thyroid hormone level changes in patients with primary biliary cholangitis （PBC） receiving ursodeoxycholic acid therapy. Methods 70 patients with primary biliary cholangitis,95 with primary liver cirrhosis,and 20 healthy persons were recruited in our hospital between January 2016 and June 2017,and all patients were treated with ursodeoxycholic acid（UDCA） for three months. Serum biochemical tests and thyroid hormone levels were detected before and after 3 month treatment. Results At the end of 3 month treatment,the liver function tests in patients with cholangitis and liver cirrhosis were improved;at presentation,serum TT3,FT3,TT4 and FT4 levels in patients with liver cirrhosis were 1.6±0.2 nmol/L,3.2±0.4 pmol/L,95.6±28.7 nmol/L and 10.3±3.6 pmol/L,and in patients with cholangitis were 1.1±0.2 nmol/L,3.0±0.3 pmol/L,88.2±26.7 nmol/L and 9.7±2.5 pmol/L,all significantly lower than 2.5±0.5 nmol/L,4.7±0.8 pmol/L,115.7±31.6 nmol/L and 13.8±4.1 pmol/L in healthy persons（P<0.05）,while serum TSH levels in the three groups were not significantly different （2.9±0.5 mIU/L and 2.9±0.7 mIU/L vs. 3.3±0.6 mIU/L,respectively,P>0.05）;at the end of 3 month treatment,serum TT3,FT3,TT4 and FT4 levels in patients with cholangitis were 2.4±0.6 nmol/L,4.5±0.8 pmol/L,108.2±36.2 nmol/L and 12.9±3.5 pmol/L,not significantly different as compared to those in healthy persons,while they were 1.2±0.3 nmol/L,3.4±0.4 pmol/L,93.7±29.8 nmol/L and 9.9±3.1 pmol/L in patients with liver cirrhosis,still significantly lower than those in healthy persons（P<0.05）. Conclusion The thyroid hormone levels decrease and might be improved after the treatment of ursodeoxycholic acid in patients with primary biliary cholangitis,which should start as early as possible.