甲亢合并重症肝功能损害的诊治

Approach on diagnosis and treatment of hyperthyroidism with severe liver damages

目的探讨甲状腺功能亢进(甲亢)合并重症肝损害患者的临床特点及治疗措施。方法回顾性分析55例甲亢合并重症肝损害患者的临床资料,根据肝功能生化指标将患者分为单纯黄疸组、转氨酶升高组、黄疸兼转氨酶升高组,探讨其临床特点、可能的相关影响因素及防治措施。结果 3组性别、年龄、甲状腺功能比较差异无统计学意义,而单纯黄疸组病程明显长于转氨酶升高组。在影响因素方面,病程长、并发甲亢性心脏病、有甲巯咪唑片长期不规则服药史或有"服用不详中药"史的患者易出现黄疸。经治疗44例患者肝功能改善;8例治疗无效;2例死亡;1例因并发肝性脑病家属放弃治疗。结论导致甲亢合并重症肝损害的因素来自多方面,重在防治。选择合适的抗甲亢方案对肝功能的恢复至关重要。

Objective To investigate the clinical features and treatments of hyperthyroidism （HT）with severe liver damages. Methods All clinical data of 55 HT patients with severe liver damages were studied retrospectively. Clinical features, correlated influential factors, measures of prevention and cure were analyzed by jaundice group, elevation of transaminase group ,jaundice with elevation of transaminase group respectively. Results The discrepancy on sex, age, thyroid function tests was not significant among the three groups, but the course of disease of jaundice group was longer obviously than that of elevation of transaminasc group （ P 〈 0.05 ）. In respect to the influential factors, the patients with long course of disease, complicated heart disease,long history of which had taken MMI irregu- larly or unkonwn traditional Chinese medicine were disposed to jaundice dangerous. Via treating,44 patients improved in liver function,8 were ineffective,2 were died, 1 was given up treatments by dependents for hepatic encephalopathy. Conclusion The factors which contribute to HT with severe liver damages patients are several. It is important to emphasize prevention and cure, and it is key to choose a suitable anti-hyperthyroidism program for the recovery of liver function.