肝硬化失代偿期并发甲状腺功能减退的临床分析

Clinical Analysis of Hypothyroidism in the Patients with Decompensate Liver Cirrhosis

目的:分析慢性乙型肝炎(慢乙肝)肝硬化失代偿期及其并发甲状腺功能功减退(甲减)患者的临床特点及临床易漏诊、漏治的原因。方法:2005年5月—2010年10月在江苏省建湖县第三人民医院住院的105例慢乙肝肝硬化失代偿期患者,将其中22例同时并发甲减的患者设为研究组,其余83例未并发甲减的患者设为对照组,回顾分析2组患者的临床资料,并同时对研究组、对照组患者追踪随访。结果:对照组甲状腺功能在正常范围;研究组的游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平显著低于对照组(P<0.01),而促甲状腺激素(TSH)水平则显著高于对照组(P<0.01);所有病例中,Child-Pugh C级患者的FT3、FT4水平显著低于Child-Pugh B级患者(P<0.05),而TSH水平则显著高于Child-Pugh B级患者(P<0.05)。研究组患者女性多于男性(P<0.05),而对照组则男性多于女性(P<0.05)。对照组患者年龄比研究组小(P<0.05)。研究组并发肝昏迷、自发性腹膜炎、肝肾综合征的患病率高于对照组(P<0.05);研究组并发上消化道出血、原发性肝癌、门静脉血栓形成的患病率与对照组无显著差异(P>0.05)。结论:约有20%的慢乙肝肝硬化失代偿期患者并发甲减;Child-Pugh C级患者比Child-Pugh B级更易发生并发甲减,且病情更严重;女性患者易并发甲减;慢乙肝肝硬化失代偿期并发甲减的患者并发症发生率较一般慢乙肝肝硬化失代偿期患者高。甲状腺激素水平可作为慢乙肝肝硬化失代偿期反映肝功能的敏感指标,有助于判断疾病严重程度及预后。

Objective：To analysis the clinical characteristics, reasons for misdiagnosis and mistreatment of hypothyroidism complication in chronic hepatitis B patients with de-compensated liver cirrhosis. Methods： A total of 105 cases of chronic hepatitis B patients with de-compensated cirrhosis that were admitted to the Third People Hospital of Jianhu County during May 2005 to October 2010 were divided into study group （N= 22）, in which the patients have hypothyroidism complication, and control group （N = 83）, in which the patients haven＇t hypothyroidism. The case histories and clinical data of three these groups of people including general information, liver function tests, and values of free tri-iodothyronine（FT3）, free thyroxine（FT4）, and thyroid-stimulating hormone（TSH） were analyzed retrospectively. The patients in the study and control groups were followed up. Results.. The functional tests of thyroid in the control group were in normal range, whereas the FT3 and FT4 level in the study group were significantly lower, and the TSH level was signif- icantly higher than the control group （P〈0. 01 ）. Within all patients, the levels of FT3 and FT4 in Child-Push C patients were significantly lower, and their TSH levels were significantly higher than those of Child-Push B patients （P〈0.05）. There were more female and elder patients in the study group than in the control group （P〈0. 05）. Patients in the study group had higher morbidity rate of hepatic encephalopathy, spontaneously peritonitis, hepatorenal syndrome than the control group while the complications of upper gastrointestinal bleeding, hepatocellular carcinoma, portal thrombosis were not different. Conclusions： Around 20 % of decompensate cirrhotic patients are complicated with hypothyroidism, in which the Child-Push C patients are more liable to get hypothyroidism and have more severe thyroid dysfunction. Female patients were subject to hypothyroidism. Chronic hepatitis B patients with decompensate cirrhosis have higher morbidity rate of hypothyroidism than the general compensate subjects. The hormone level of thyroid may be a sensitive parameter to reflect a deteriorated liver function in chronic hepatitis B patients with decompensate liver cirrhosis and facilitate the prediction of the severity and prognosis of the disease.