儿童青少年Graves病及肝功能损害的临床特点

目的探讨儿童和青少年甲状腺机能亢进症（hyperthyroidism，HT）肝功能损害及其相关因素。方法对未经治疗119例儿童和青少年毒性弥漫性甲状腺肿（Graves）患者分别采用化学发光免疫分析法检测FT3、VF4、s-TSH和放射免疫法测定CG血清。用速率生化分析法检测肝功能谷丙转氨酶（ALT）、碱性磷酸酶（ALP）、谷草转氨酶（AST）及总胆红素（TB）血清，并排除肝脏本身病变所致肝功能异常。结果儿童和青少年Graves病临床表现与成人相仿。119例儿童和青少年Graves患者合并肝功能损害35例为29．4％，儿童组肝功能损害9例为7．6％，青少年组肝功能损害26例为21．8％。甲亢性肝损害与年龄密切相关，两组年龄差异有显著意义（P＜0．01），与性别无关（P＞0．05）。肝功能指标为成人不同以ALP异常为85．7％（30／35），其次ALT为71．4％（25／35），AST及TB为54．3％（19／35）异常，甘胆酸（CG）明显增高为94．3％（33／35），35例甲亢性肝功能损害患者血清FT3及FT4测定明显高于无肝功能损害患者（P＜0．05），而血清s—TSH则明显差异比无肝损害者低（P＜0．01）。结论儿童和青少年甲亢随年龄增长，发病率逐渐增加，治疗前易致肝损害，肝损害异常指标是以碱性磷酸酶增高，甲亢性肝功能损害发生率与甲状腺激素水平和年龄密切相关。

Clinical features of thyrotoxic hepatic damnification in children and adolescent with hyperthyroidism

Objective To discuss thyrotoxic hepatic damnification in children and adolescent with hyperthyroidism and its correlative factors.Methods The sera of 119 untreated children and adolescent with hyperthyroidism were collected and separately detected for FT3 and FT4 levels by chemiluminescence's immunoassay(CLIA);cholyglycine(CG) by radioimmunoassay;aminotransferase(ALT),alkaline phosphates(ALP),aspartase aminotransferase(AST) and total bilirubin(TBILI) by biochemical assay.Those patients with abnormal hepatic function parameters caused by hepatic diseases were excluded from this study.Results The clinical features of thyrotoxic hepatic damnification in children,adolescent and adult with hyperthyroidism were similar.Thirty five of 119 children and young Graves patients merged the liver function damage,accounting for 29.4%,including 9 children's cases(7.6%) and 26 young cases(21.8%).The difference between the two groups was significant,P<0.01.Thyrotoxic hepatic damnification closely correlated with age,and the two groups had a significance difference,P<0.01,but did not correlate with sex,P>0.05.The liver function indexes of the children were different from ones of the adult,especially in ALP(30/35,85.7%);AST(19/35,54.3%);TB(5/35,14.3%).The level of CG obviously increased and its abnormal rate was 94.3%(33/35).The levels of FT3 and FT4 in patients with thyrotoxic hepatic damnification were significantly higher than those in patients without thyrotoxic hepatic damages,P<0.05;the level of s-TSH in patients with thyrotoxic hepatic damnification was significantly lower than that in patients without thyrotoxic hepatic damages,P<0.01.Conclusions Increased alkaline phosphate enzyme is the most common abnormal hepatic function parameter in patients with thyrotoxic hepatic damages,and the possibility and severity of thyrotoxic hepatic damnification is correlated with age and the level of thyroid hormones.