晚期血吸虫病患者甲状腺激素监测的临床意义

Clinical significance of thyroid hormone monitoring in patients with advanced schistosomiasis

目的观察晚期血吸虫病患者血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、反三碘甲状腺原氨酸(rT3)及其比值的升降变化,评价其预后判断价值。方法将138例晚期血吸虫病患者按尿钠排泄率分为轻型(35 mmol/d)85例、中型(10～30 mmol/d)27例、重型(<10 mmol/d)26例。用放射免疫法检测晚期血吸虫病患者治疗前、后和30名正常对照者T3、T4、rT3水平,计算T3/rT3比值及T4/rT3比值,同时检测肝功能指标[总胆红素(TBil)、总蛋白(TP)、白蛋白(Alb)、丙氨酸氨基转移酶(ALT)],分析其与肝脏功能代偿机制的相关性及其与预后的关系。结果 138例晚期血吸虫病患者中轻型患者T3、T4水平均低于正常对照组(P<0.05),中、重型组较轻型组下降幅度更大(P<0.01、P<0.001);患者组rT3水平与正常对照组比较有不同程度升高,且中、重型组较轻型组上升幅度更为明显(P<0.001)。T3/rT3及T4/rT3比值随患者临床分型的加重(轻、中、重型)而进一步下降(P<0.01、P<0.001)。26例晚期血吸虫病重型患者中伴难治性腹水者治疗前T3/rT3及T4/rT3比值均低于伴非难治性腹水者(P<0.001);出院时伴非难治性腹水患者T3/rT3及T4/rT3比值明显升高(P<0.05),而伴难治性腹水患者则持续降低(P<0.05),提示预后不良。动态监测26例晚期血吸虫病重型患者T3/rT3及T4/rT3比值,19例最终痊愈患者逐渐上升直至恢复至正常水平,4例病情加重者呈逐步下降趋势,而3例死亡病例则快速下降至最低值(0.10±0.05)。结论晚期血吸虫病患者T3/rT3和T4/rT3比值变化为肝功能受损的敏感指标,其动态监测对晚期血吸虫病患者的预后判定有重要意义。

Objective To observe the changes of serum triiodothyronine（T3）,thyroxine（T4）,reverse T3（rT3） and the ratios of T3/rT3 and T4/rT3 in advanced schistosomiasis patients,and evaluate the prognostic values.Methods According to the ratios of urinary sodium,138 patients with advanced schistosomiasis were classified into minor grade（35 mmol/d,85 cases）,moderate grade（10-30 mmol/d,27 cases） and severe grade（10 mmol/d,26 cases）.By radioimmunoassay,the levels of T3,T4 and rT3 in advanced schistosomiasis patients were measured before and after therapy,and the results were compared with those of 30 healthy controls.The T3/rT3 ratio and T4/rT3 ratio were also calculated.Hepatic function indices [total bilirubin（TBil）,total protein（TP）,albumin（Alb）and alanine aminotransferase（ALT）] were detected simultaneously.The relationship of the correlation and prognosis of compensatory mechanism was analyzed.Results The levels of T3 and T4 in the minor grade group were lower than those in healthy controls（P〈0.05）,and the levels of T3 and T4 in the moderate grade and severe grade groups decreased sharply（P〈0.01,P〈0.001）.The level of rT3 in patients with advanced schistosomiasis was higher than that in the healthy controls,and the levels of rT3 in moderate grade and severe grade groups increased significantly（P〈0.001）.The ratios of T3/rT3 and T4/rT3 increased gradually with the severity of grade（minor grade,moderate grade and severe grade,P〈0.01,P〈0.001）.The ratios of T3/rT3 and T4/rT3 in 26 severe grade patients with refractory ascites were lower than those with uncomplicated ascites（P〈0.001）.When discharging from the hospital,the ratios of T3/rT3 and T4/rT3 in patients with uncomplicated ascites increased significantly（P〈0.05）,while those with refractory ascites had a downward tendency,indicating the poor prognosis.The ratios of T3/rT3 and T4/rT3 in 26 severe grade patients were dynamically monitored,including 19 cured patients gradually recovering with time,4 patients showing a decrease trend with the progression of the disease,and 3 cases of deaths going down and reaching the minimum value（0.10±0.05）.Conclusions The ratios of T3/rT3 and T4/rT3 in advanced schistosomiasis patients are sensitive indicators for liver function lesion,especially for monitoring the prognosis dynamically in patients with advanced schistosomiasis.