甲状腺功能亢进性肝损害的临床特点及治疗

Clinical Characteristics and Treatment of Hyperthyroidism Liver Injury

目的总结甲状腺功能亢进性肝功能损害(HLI)的临床特点和治疗方案。方法对2008年1月-2010年12月诊治的49例HLI患者临床资料进行回顾性总结分析,据其治疗方案的不同分抗甲状腺治疗组和单纯保肝治疗组,比较二组患者治疗后肝功能恢复情况。结果所有患者入院时均存在不明原因肝功能不全,而后明确为HLI。其中女29例(59.2%),男20例(40.8%),年龄10～70岁,平均45岁。症状主要表现为体重下降(65.3%),心悸(51.1%),怕热多汗(49.0%),厌油纳差、食欲减退(44.9%)。主要体征包括甲状腺肿大(36.7%),双下肢水肿(24.5%),心界扩大(16.3%),皮肤巩膜黄染(14.3%),肝脾肿大(12.2%)等。肝功能检验异常主要表现为谷丙转氨酶升高(68.9%),谷草转氨酶升高(57.8%)为主,其次是谷氨酰转移酶(69.4%)、直接胆红素(59.2%)、总胆红素(44.9%)、碱性磷酸酶(42.9%)、乳酸脱氢酶(26.5%)升高,以及白蛋白(32.7%)下降。死亡3例,病死率6.1%。采用Wilcoxon秩和检验结果提示抗甲状腺治疗组的总胆红素和直接胆红素低于单纯保肝治疗组,组间差异有统计学意义(P<0.05)。结论此类患者可同时具备甲状腺功能亢进和肝功能不全的临床表现,肝功能常表现为淤胆型肝炎。HLI总体预后较好,抗甲状腺治疗是该病的关键。

Objective To investigate the clinical characteristics and treatment of hyperthyroidism liver injury（HLI）.Methods Data of 49 patients with HLI who were treated in our hospital from January 2008 to December 2010 were retrospectively analyzed.According to the different treatment regime,the patients were divided into two groups： the group of anti-thyroid treatment and the group of simple liver-protection.We compared the condition of liver function recovery after treatment between the two groups.Results All patients had hepatic insufficiency with unknown reasons at the admission to the hospital,and later were diagnosed to have HLI.There were 29（59.2%） female and 20（40.8%） male patients with their age ranging from 10 to 70 years old,averaging 45.08 ± 1.90.Weight loss（65.3%） was the most frequent symptom,followed by heart palpitations（51.1%）,hotness and hydrosis（49.0%）,and being sick of fat and anorexia（44.9%）.The main signs included 18 cases（36.7%） of thyroid enlargement,12（24.5%） of lower lamb edema,8（16.3%） of heart enlargement,7（14.3%） of jaundice,and 6（12.2%） of hepatosplenomegaly.The elevations of alanine aminotransferase（ALT）（68.9%） and aspartate aminotransferase（AST）（57.8%） were most frequently detected,followed by increased gamma glutamyltransferase（GGT）（69.4%）,direct bilirubin（DB）（59.2%）,total bilirubin（TB）（44.9%）,alkaline phosphatase（ALP）（42.9%） and lactic dehydrogenase（LDH）（26.5%）,and decreased albumin（ALB）（32.7%）.The total mortality was 6.1%（3/49）.The results of Wilcoxon test indicated that TB and DB values of the thyroid treatment group were significantly lower than those of the simple liver-protection group（P〈0.05）.Conclusions These patients present the clinical manifestations of both hyperthyroidism and liver dysfunction,and the results of liver functions were characterized by cholestatic hepatitis.The disease has a relatively good prognosis,and the anti-thyroid medication is the key to the recovery of liver function.