Graves病患者并发甲亢性肝功能损害的临床特征及相关因素分析

Clinical characteristics of Graves' disease and factors related to hyperthyroid liver injury

目的探讨Graves病患者并发甲状腺功能亢进症(甲亢)性肝功能损害的临床特征及相关因素。方法 230例Graves病患者中,并发甲亢性肝功能损害105例(A组),肝功能正常125例(B组),初诊患者98例(C组),使用抗甲状腺药物治疗在半年以内且未同时使用保肝药物者132例(D组)。检测患者肝功能、血清甲状腺激素及自身抗体水平,分析甲亢性肝功能损害的临床特点及相关因素。结果 A组ALT、AST、γ谷氨酰转肽酶(GGT)、TBil、ALP、FT_3、FT_4、促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)水平均高于B组(P<0.05),而两组甲状腺球蛋白抗体(TGAb)比较差异无统计学意义(P>0.05)。A组患者ALT、AST、GGT与FT_3、FT_4、TRAb、TPOAb均呈正相关(P<0.05)。C组甲亢性肝功能损害的发生率高于D组(66.3%vs.30.3%)(P<0.05)。D组患者中,抗甲状腺药物治疗时间在12周内和12周以上并发甲亢性肝功能损害患者分别为43例(63.2%)和29例(45.3%),比较有统计学差异(P<0.05)。结论 Graves病患者并发甲亢性肝功能损害较常见,最常见的异常指标是ALP和ALT。临床上对于TRAb和TPOAb滴度高的Graves病患者应重视肝功能损害,必要时给予相应的预防和治疗。

Objective To investigate the clinical characteristics and related factors of hyperthyroid liver injury in the patients with Graves＇disease .Methods Of 230 patients with Graves＇ disease ,105 cases were with hyperthyroid liver injury（group A） ,and 125 cases were with normal liver function（group B） ,98 cases were the newly diagnosed as Graves＇disease（group C） and 132 cases were with anti-thyroid medication in less than six months and without using hepatoprotective therapy .The liver function ,serum thyroid hormones and autoantibodies levels were detected .Clinical characteristics and the factors related to hyperthyroid liver injury were analyzed .Results The levels of ALT ,AST , GGT ,TBil ,ALP ,FT3 ,FT4 ,TRAb and TPOAb were higher in group A than those in group B （P〈0 .05） ,but the TGAb was not significantly different between two groups of A and B （P〉0 .05） . The levels of AST ,ALT and GGT in group A were positively correlated with FT 3 ,FT4 ,TPOAb and TRAb（P＆lt;0 .05） .The incidence of hyperthyroid liver injury in group C was higher than that in group D （66.3% vs .30.3% ）（P＆lt;0 .05） .In group D ,the incidence rates of hyperthyroid liver injury were 63.2% and 45.3% by treating with anti-thyroid drug for 12 weeks and more than 12 weeks , respectively （ P＆lt;0 .05 ） .Conclusion Graves ＇ disease patients with hyperthyroid liver injury is common ,in which the most common abnormal indicators are ALP and ALT .The attention should be paid to the liver injury and the appropriate prevention and treatment need to be considered in the patients with high levels of TRAb and TPOAb .