慢性乙型肝炎患者血清AST/ALT比值与甲状腺激素的关系探讨

目的通过检测临床确诊为慢性乙型肝炎患者血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、甲状腺激素T3、T4及促甲状腺素（TSH）含量,进一步探讨慢性乙型肝炎患者肝损情况与甲状腺分泌功能的关系。方法收集2009年1-4月79例确诊为慢性乙型肝炎患者（病例组）血清标本,分别检测其ALT、AST、甲状腺激素T3、T4及TSH含量。以同期健康体检者30例作为对照组。比较两组的差异及各指标间的相关性。结果病例组AST为（87±113）U/L、ALT为（135±241）U/L、AST/ALT为0.97±0.57、TSH为（1.63±1.29）mU/L、T3为（1.61±0.52）ng/mL、T4为（10.7±2.9）μg/dL,对照组分别为（23±5）U/L、（18±5）U/L、1.31±0.26、（2.13±0.90）mU/L、（1.19±0.16）ng/mL和（8.6±0.9）μg/dL,两组各指标比较均有统计学差异（P〈0.01）。所有指标均正常的共有6例（7.6%）,有73例（92.4%）存在不同程度的指标异常;在68例AST/ALT比值降低的慢性乙型肝炎患者（93.2%）中,伴有单纯T4升高的有11例（16.2%）,单纯T3升高的有4例（5.9%）,T3、T4同时升高的有11例（16.2%）,T3、T4同时升高且TSH降低的有2例（2.9%）,1例T4升高且TSH降低（1.5%）,1例仅TSH升高（1.5%）;在4例AST/ALT比值正常的慢性乙型肝炎患者（5.5%）中,有1例T3、T4同时升高且TSH降低,1例T3和T4同时升高,1例单纯T4升高,1例单纯TSH降低;有1例仅AST/ALT比值升高而其他项正常。结论慢性乙型肝炎患者除AST/ALT比值异常外,还同时伴有不同程度的甲状腺激素指标异常,其原因可能与慢性乙型肝炎应用干扰素治疗时甲状腺功能受损有关。

Relationship between AST/ALT Ratio and Thyroid Hormone Level in Patients with Chronic Hepatitis B

Objective To explore the relationship between liver damage and the secretion function of thyroid by detecting the serum alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,T3,T4,and thyroid stimulating hormone（TSH）in patients with chronic hepatitis B.Methods The serum samples of 79patients with chronic hepatitis B from January to April 2009were collected,and the ALT,AST,T3,T4,and TSH concentrations were detected.Another 30healthy subjects were selected as the control.The detected indexes were compared between the two groups.Results In the case group,the concentration of AST was（87±113）U/L,ALT was（135±241）U/L, AST/ALT was 0.97±0.57,TSH was（1.63±1.29）mU/L,T3was（1.61±0.52）ng/mL,and T4was （10.7±2.9）μg/dL;while in the control group,the concentrations of the items were（23±5）U/L,（18±5）U/L, 1.31±0.26,（2.13±0.90）mU/L,（1.19±0.16）ng/mL,and（8.6±0.9）μg/d L,respectively.The differences between the two groups were significant（P0.01）.Among the 79case,6（7.6%）had a totally normal result,and 73（92.4%）had an abnormal result.There were 68patients who had a low ratio of AST/ALT,among whom 11 （16.2%）had a simple T4elevation,4（5.9%）had a simple T3elevation,11（16.2%）had an elevation of both T3and T4,2（2.9%）had an elevation of both T3and T4and a depression of TSH,1（1.5%）had an elevation of T4and a depression of TSH ,and 1（1.5% ）had a simple TSH elevation.There were 4cases who had a normal ratio of AST/ALT,among whom 1had an elevation of both T3and T4and a depression of TSH,1had an elevation of both T3and T4,1had a simple T4elevation,and 1had a simple TSH depression.There was 1case who had only an elevation of AST/ALT.Conclusion Most of the patients with chronic hepatitis B have an abnormal result of thyroid hormone together with the abnormal ratio of AST and ALT.The reason mainly lies in the damage of thyroid function by the usage of interferon for the therapy of chronic hepatitis B.