Graves病患者甲亢性肝损害及其相关因素分析

Hepatic dysfunction in patients with Graves' disease and its correlative factors

目的探讨Graves病(GD)患者甲亢性肝损害的发生率及其相关因素。方法GD患者280例,分为未治组(131例)和经治组(149例),检测肝功能指标、血清甲状腺激素水平、甲状腺自身抗体。对其肝功能损害的发生率、临床特点及相关因素进行分析。结果在未治组甲亢性肝功能损害的发生率为70.99%,经治组为61.07%;甲亢性肝功能损害最常见的异常指标是碱性磷酸酶(ALP)增高,未治组、经治组分别为57.3%、51.0%;血清谷丙转氨酶(ALT)异常在两组的发生率分别为28.2%、21.5%;血清谷草转氨酶(AST)异常在两组的发生率分别为18.3%、15.4%;总胆红素异常在两组的发生率分别为21.4%、20.1%;谷酰胺转肽酶(GGT)异常的发生率未治组和经治组分别为10.7%、4.7%;甲亢性肝功能损害的发生与病程、甲状腺疾病家族史、性别、TGAb水平、TMAb水平无关,与年龄、甲状腺激素水平有关。结论GD患者甲亢性肝损害较常见,肝功能损害最常见的异常指标是ALP、ALT,甲亢性肝功能损害与甲状腺激素水平、年龄有关。

Objective To investigate the incidence and the possible risk factors of hepatic dysfunction in patients with Graves＇ disease（GD）.Methods Totally 280 outpatients with hyperthyroidism（caused by GD） were divided in two groups： untreated group（131 patients） and treated group（149 patients）.The hepatic function,serum thyroid hormone,TGAb and TMAb were detected for analysis of the incidence,clinical characteristics and correlative factors of the hepatic dysfunction.Results Patients who had at least one abnormal result of liver function test accounted for 70.99% in untreated group and 61.07% in treated group.The most common abnormal hepatic function parameter in patients with thyrotoxic hepatic lesion was increased alkaline phosphate enzyme（ALP）,which was 57.3% in untreated group and 51.0% in treated group.Abnormalities of alanine transaminase（ALT）,aspartate transaminase（AST）,gamma-glutamyl tyanspeptidase（GGT） and total bilirubin（TBIL） were 28.2%（37/131）,18.3%（24/131）,10.7%（14/131） and 21.4%（28/131） in untreated group and 21.5%（32/149）,15.4%（23/148）,4.7%（7/149） and 20.1%（30/149） in treated group,respectively.The possibility of thyrotoxic hepatic dysfunction was correlated with the patients＇ age and FT3 and FT4 levels,but not with the genesis and course of disease,sex,family history of hyperthyroidism,or levels of TGAb and TMAb.Conclusion Abnormal results of liver function test are commom in patients with hyperthyroidism.Increased alkaline phosphate enzyme and alanine transaminase are the most common abnormal hepatic function parameters;the possibility of thyrotoxic hepatic dysfunction is correlated with patients＇ age and the level of thyroid hormones.