118例甲亢性肝损害的临床特点分析

Clinical characteristics of 118 cases of hyperthyroidism with hepatic dysfunction

目的探讨甲状腺功能亢进症(甲亢)肝损害的临床特点。方法收集224例甲亢病例的临床资料,从中选出肝损害组及无肝损害组,从临床症状、甲状腺功能指标、肝功能指标、合并症及临床随访等进行分析。结果在224例甲亢患者中有118例(52.7%)患者发生甲亢性肝损害,其中85例(72.0%)病程6月以上,70例(59.3%)临床无明显自觉症状。肝功异常表现为2种或2种以上指标异常,且ALT、AST升高与FT3、FT4升高成正相关;甲亢性肝损害组合并甲亢性心脏病、甲亢性肌病、周期性麻痹及浸润性突眼的发生率明显高于无肝损害组(P<0.05)。半数以上患者经抗甲亢药物治疗的同时注意休息、营养支持及保肝治疗肝功恢复正常。无效者使用糖皮质激素及保肝治疗后绝大部分好转。结论甲亢性肝损害发病率高,临床表现缺乏特异性,与甲状腺激素水平及甲亢并发症有密切关系,糖皮质激素对部分肝功损害严重的甲亢患者有效。

Objective To study clinical characteristics of hyperthyroidism with hepatic dysfunction.Methods 224 diagnosed hyperthyroid patients were present or not,the clinical manifestation,liver function tests,serum thyroid hormones,co-exist diseases and clinical treatment were reexamined in these patients.Results The prevalence of hepatic dysfunction was seen in 118 cases（52.7%） with illness duration over 6 months in 85 cases（72.0%）,asymptomatics was seen in 70 cases（59.3%）.Increased ALP and ALT were the most familiar abnormal hepatic function parameters.In the patients with hepatic dysfunction,the serum ALT and AST levels were correlated to FT3 and FT4 levels.The prevalence of co-existed hyperthyroid heart disease,myopathy,periodical paralysis and infiltrated exopthalmos was significantly higher in patients with hepatic dysfunction than normal hepatic function（P0.05）.Over half patients with hepatic dysfunction recovered from antihyperthyroidism combined with resting,nutrition support and protection of liver function.Those of no effects from above treatment mostly recovered from corticosteroids.Conclusion Hepatic dysfunction was common in hyperthyroidism with asymptomatics.There was correlation between the elevation of liver function and the thyroid hormone levels,coexist diseases.Corticosteroids has effect to some hyperthyroidism with severe hepatic dysfunction.