甲状腺功能亢进症并肝损害的临床特征与治疗转归分析

目的总结甲状腺功能亢进症(甲亢)并肝损害的临床特征与治疗转归。方法回顾性分析2009年6月-2010年6月入院诊治的119例甲亢并肝损害患者(肝损害组)的临床特点与治疗转归资料,并与同期247例甲亢不伴有肝损害患者(无肝损害组)作比较。结果肝损害组占同期甲亢患者的30.4%,其中108例(90.8%)无明显肝损害的临床表现,以丙氨酸氨基转移酶和天门冬酸氨基转移酶升高为主,多为轻、中度升高;患者高代谢症候群、突眼、甲状腺肿大发生率及肿大程度明显高于无肝损害组,心率明显快于无肝损害组,血清游离三碘甲状腺原氨酸、游离甲状腺素及吸131I率明显高于无肝损害组,而体质量指数则明显低于无肝损害组(P<0.05)。两组性别、年龄、病程、甲亢类型、甲状腺球蛋白抗体及甲状腺微粒体抗体滴度差异无统计学意义(P>0.05)。肝损害组患者随访18个月以上,101例131I治疗患者随着甲亢控制,肝功能恢复正常,未见有再发肝损害;18例抗甲状腺药物治疗,其中10例随着甲亢控制,肝功能逐渐恢复正常;8例随着甲亢控制,肝功能逐渐恢复正常,但随着甲亢复发,再出现肝功能损害。结论肝损害是甲亢的常见并发症之一,其肝损害症状较轻,多数患者不典型,但并随甲亢病情较重。护肝治疗结合恰当的抗甲亢治疗预后良好。

Clinical Features and Treatment Outcomes Analysis of Hyperthyroidism with Hepatic Injury

Objective To discuss the clinical features and treatment outcomes of hyperthyroidism with hepatic injury.Methods We retrospectively analyzed the clinical characteristics and treatment outcomes of 119 patients(hepatic injury group) with hyperthyroidism with hepatic injury treated in our hospital from June 2009 to June 2010.The data were compared with those of 247 patients(non hepatic injury group) with hyperthyroidism but without hepatic injury.Results The prevalence rate of hyperthyroidism with hepatic injury was 30.4% in all patients with hyperthyroidism,among whom 108 patients(90.8%) had no obvious clinical manifestations of hepatic injury,and they mainly had mild to moderate rising of alanine transaminase and aspartate transaminase.In the hepatic injury group,the incidence of high metabolic syndrome,exophthalmos,thyroid enlargement was significantly higher than those in the non hepatic injury group;the heart rate was distinctly faster than that in the non hepatic injury group.The content of serum free triiodothyronine,free thyroxine and 131I absorbing rate were also significantly higher than those in the non hepatic injury group,while the body mass index was significantly lower than that in the non hepatic injury group(P<0.05).There was no significant difference(P>0.05) in sex,age,hyperthyroidism type,the thyroglobulin antibodies and thyroid microsome antibodies titer between the two groups(P>0.05).All patients of hepatic injury group were followed up for 18 months.A total of 101 patients treated by 131I for hyperthyroidism control,had their liver functions recovered without recurrent liver damage.Eighteen patients treated by anti-thyroid medication including 10 patients with hyperthyroidism control also had their liver functions gradually returned to normal;8 patients with hyperthyroidism control had their liver function gradually returned to normal,with hyperthyroidism recurrence and recurrent liver damage.Conclusions Hepatic injury is one of the common complications of hyperthyroidism.The hepatic injury symptom is minor,and not very typical in most patients.However,the hyperthyroidism can be serous.Liver protective treatment combined with proper treatment of hyperthyroidism can achieve better prognosis.