甲波尼龙冲击治疗甲状腺相关性眼病出现肝损害的相关因素分析

Risk factors causing liver dysfunction in intravenous methylprednisolone therapy for patients with thyroid associated ophthalmopathy

目的分析大剂量甲波尼龙静脉冲击治疗甲状腺相关性眼病发生肝损害的特点及危险因素，以预防其发生。方法选取2010年1月至2014年10月甲状腺相关性眼病，并行大剂量甲波尼龙静脉冲击治疗的患者，回顾性分析其临床资料，比较治疗后肝功正常组和肝功异常组临床特征差异，采用logistics回归分析，识别出现肝损害的危险因素。结果共纳入行冲击治疗的甲状腺相关性眼病患者153例，其中有53例（34．6％）患者出现肝功能异常，表现为丙氨酸氨基转移酶（ALT）、谷胺酰转肽酶（GGT）升高（P〈0.05），其中9例（5．88％）患者ALT升高达3倍（120U／L）以上。男性、有饮酒史的患者易出现肝损害。肝功异常组血清游离三碘甲腺原氨酸（F13）、血清游离甲状腺素（FT4）、天门冬氨酸氨基转移酶（AST）、ALT、GGT水平治疗前均明显高于肝功正常组（P〈0.05）。Logistics回归分析显示GGT是肝功能异常的危险因素；肝功能异常患者停用甲波尼龙并加用保肝药物治疗，1个月后复查转氨酶水平均可恢复正常。结论甲波尼龙冲击治疗甲状腺相关眼病肝功能损害风险高，GGT指标是发生肝损害的危险因素，呈正相关，冲击治疗过程中应注意防治激素引起的肝损害。

Objective To investigate the characteristics and risk factors causing liver dysfunction for patients with thyroid associated ophthalmopathy （TAO）. Methods The TAO patients terated with methylprednisolone were selected from Jan 2010 to Oct 2014. The clinical data were retrospectively studied and compared between the groups with normal hepatic function and the groups with hepatic dysfunction before and after treatment. The risk factors of hepatic dysfunction was identified using the Logistics regression analysis. Results A total of 153 TAO patients treated with methylprednisolone was included. The incidence of hepatic dysfunction was 34. 6% （53 cases）. Increased ALT, GGT level and normal bilirubin level were found. In 9 cases（5. 88% ）, ALT level increased more than 3 times （ 〉 120 U/L）. Male and drinker were prone to suffer hepatic dysfunction. Before treatment, serum 1713, FT4, AST, ALT, GGT levels were significantly higher in the group of hepatic dysfunction than that in the group of normal hepatic function （P 〈 0. 05）. Logistics regression analysis showed that GGT was the risk factror of hepatic dysfunction. Liver function normalized after methylprednisolone withdrawal for 1 month. Conclusions Liver dysfunction is a common adverse event in the treatment of TAO patients with methylprednisolone. GGT level might be a risk factor of liver dysfunction. Monitoring liver function should be emphasized in the treatment of TAO patients using methylprednisolone.