慢性乙型肝炎患者甲状腺激素水平与HBsAg水平及病情严重程度的相关性分析

An analysis on the correlation between thyroid hormone and HBsAg levels and disease severity of hepatitis B patients

目的 分析慢性乙型肝炎(CHB)患者甲状腺激素水平与乙型肝炎表面抗原(HBsAg)水平及病情严重程度的相关性。方法 选择115例2021年7月—2023年7月在中江县人民医院进行治疗CHB患者为研究对象,设为观察组,另选同期于我院体检中心体检的100名健康者将其纳入对照组,比较两组甲状腺激素[游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)]水平及HBsAg水平,观察不同病情严重程度、不同肝硬化病理分期患者以上指标水平,另采用Pearson相关性分析以上指标与病情严重程度、肝硬化病理分期的相关性。结果 与对照组血清FT3、FT4、TSH、HBsAg水平[(4.95±0.61)pmol/L、(17.56±2.34)pmol/L、(2.94±0.31)μIU/mL、(0.04±0.01)IU/mL]相比,观察组FT3、FT4、TSH[(3.75±0.42)pmol/L、(15.41±2.13)pmol/L、(2.67±0.45)μIU/mL]明显下降,HBsAg水平(3.11±1.12)IU/mL显著升高(t=16.973、7.051、5.048、27.401,P<0.05);轻度CHB患者FT3、FT4、TSH水平[(4.15±0.51)pmol/L、(16.24±2.08)pmol/L、(2.23±0.65)μIU/mL]高于中度患者[(3.73±0.49)pmol/L、(15.23±2.31)pmol/L、(1.94±0.52)μIU/mL],中度患者FT3、FT4、TSH水平高于重度患者[3.34±0.37)pmol/L、(14.19±2.04)pmol/L、(1.66±0.67)μIU/mL],三组患者HBsAg水平[(2.45±0.63)IU/mL、(2.84±0.75)IU/mL、(3.23±1.01)IU/mL]逐渐升高(F=25.761、7.604、7.513、8.039,P<0.05);肝纤维化S1患者的血清FT3、FT4、TSH水平[(4.06±0.61)pmol/L、(16.54±2.23)pmol/L、(2.62±0.54)μIU/mL]高于S2[(3.75±0.53)pmol/L、(15.17±2.21)pmol/L、(2.17±0.62)μIU/mL],S2高于S3[(3.37±0.49)pmol/L、(14.02±2.45)pmol/L、(1.83±0.42)μIU/mL],S3高于S4[(2.68±0.47)pmol/L、(12.81±2.07)pmol/L、(1.36±0.57)μIU/mL],四组HBsAg水平[(1.85±0.21)IU/mL、(2.09±0.57)IU/mL、(2.64±0.62)IU/mL、(3.08±0.97)IU/mL]逐渐升高(F=35.438、11.509、23.256、17.201,P<0.05);相关性分析显示,甲状腺激素水平与CHB病情严重程度、CHB肝纤维化严重程度呈负相关(r=-0.458、-0.651、-0.715、-0.694、-0.597、-0.712,P<0.05),HBsAg水平与CHB病情严重程度、CHB肝纤维化严重程度呈正相关(r=0.531、0.673,P<0.05)。结论 CHB患者甲状腺激素水平与HBsAg水平及病情严重程度关系密切,联合检测FT3、FT4、TSH及HBsAg可有效评估病情严重程度、预测纤维化进程。

Objective To analyze the correlation between the levels of thyroid hormone and hepatitis B surface antigen(HBsAg)and the severity of chronic hepatitis B patients(CHB).Methods A total of 115 CHB patients admitted from July 2021 to July 2023 were selected as the study subjects of the observation group,and 100 healthy subjects who underwent physical examination during the same period were selected as the control group.The levels of thyroid hormone[free three iodine thyroid original glycine(FT3)and free iodine thyroid four original glycine(FT4),thyroid stimulating hormone(TSH)]and HBsAg levels were compared between these two groups of patients.The association between theses parameters with the severity of illness,and pathological stages of liver cirrhosis were analyzed by Pearson correlation analysis.Results Compared with the levels of serum FT3,FT4,TSH and HBsAg[(4.95±0.61)pmol/L,(17.56±2.34)pmol/L,(2.94±0.31)μIU/mL,and(0.04±0.01)IU/mL,respectively]in the control group,the levels of FT3,FT4 and TSH in the observation group,[(3.75±0.42)pmol/L,(15.41±2.13)pmol/L,and(2.67±0.45)μIU/mL,respectively]were significantly decreased,whereas the HBsAg level[(3.11±1.12)IU/mL]was significantly increased(t=16.973,7.051,5.048,27.041,P<0.05).The levels of FT3,FT4 and TSH in mild hepatitis B patients were(4.15±0.51)pmol/L,(16.24±2.08)pmol/L,and(2.23±0.65)μIU/mL,respectively,which were higher than those of(3.73±0.49)pmol/L,(15.23±2.31)pmol/L,and(1.94±0.52)μIU/mL in moderate hepatitis B patients.The levels in moderate patients were higher than those of 3.34±0.37)pmol/L,(14.19±2.04)pmol/L,and(1.66±0.67)μIU/mL in severe hepatitis B patients.The HBsAg levels in these three groups were gradually increased[(2.45±0.63)IU/mL,(2.84±0.75)IU/mL,(3.23±1.01)IU/mL,F=25.761,7.604,7.513,8.039,P<0.05].The serum FT3,FT4 and TSH levels in patients with hepatic fibrosis S1 were(4.06±0.61)pmol/L,(16.54±2.23)pmol/L,and(2.62±0.54)μIU/mL,respectively,which were higher than those of(3.75±0.53)pmol/L,(15.17±2.21)pmol/L,and(2.17±0.62)μIU/mL in S2 patients,The levels of S2 patients were higher than those of(3.37±0.49)pmol/L,(14.02±2.45)pmol/L,and(1.83±0.42)μIU/mL in S3 patients,and the levels of S3 patients was higher than those of[(2.68±0.47)pmol/L,(12.81±2.07)pmol/L,and(1.36±0.57)μIU/mL in S4 patients.The HBsAg levels were gradually increased in these four groups[(1.85±0.21)IU/mL,(2.09±0.57)IU/mL,(2.64±0.62)IU/mL,(3.08±0.97)IU/mL,and F=35.438,11.509,23.256,17.201,respectively,P<0.05).By Correlation analysis it was found that the level of thyroid hormone was negatively correlated with the severity of hepatitis B and liver fibrosis(r=-0.458,-0.651,-0.715,-0.694,-0.597,-0.712,P<0.05).HBsAg level was positively correlated with the severity of hepatitis B and liver fibrosis(r=0.531,0.673,P<0.05).Conclusion The level of thyroid hormone in patients with hepatitis B is closely related to the level of HBsAg and the severity of the disease.A combined detection of FT3,FT4,TSH and HBsAg may effectively evaluate the severity of the disease and predict the progression of fibrosis.