甲亢合并严重肝损的治疗策略分析

Analysis on treatment strategy of hyperthyroidism combined with severe liver injury

目的比较甲亢合并严重肝损时针对甲亢的不同治疗方法,探讨有效的治疗方案。方法回顾性分析2003年6月～2017年6月来我院住院及随访的甲亢合并严重肝损的患者共47例(慢乙肝重度20例及肝衰竭27例)的临床资料,分析临床特点、针对甲亢的治疗分为未抗甲状腺治疗组、抗甲状腺药物治疗组、碘131组,比较不同治疗后结果。结果 20例慢乙肝重度患者未抗甲状腺治疗组4例好转,2例无效,抗甲状腺药物治疗组12例全部好转,碘131治疗组2例全部好转。抗甲状腺药物治疗组随访三个月,未出现肝损加重及白细胞减少等抗甲状腺药物副作用。肝衰竭患者中未抗甲状腺治疗组10例死亡7例、2例无效,1例好转。抗甲状腺药物治疗组9例好转,2例死亡。碘131组共6例,5例均好转,1例无效。抗甲状腺药物治疗组及碘131组有效率高于未抗甲状腺药物治疗组,差异比较有统计学意义(P <0.05);慢乙肝重度及肝衰竭患者中抗甲状腺药物治疗组及碘131治疗组FT3、ALT、TB较未抗甲状腺治疗组降低,差异比较有统计学意义(P <0.05),TSH较未抗甲状腺治疗组升高,差异比较有统计学意义(P <0.05)。结论甲亢合并严重肝损的治疗主要是针对不同的病因采用不同治疗方法,严重肝损的患者在排除甲状腺药物导致的肝损的基础上使用抗甲状腺药物是安全有效的,碘131治疗前后联合血浆置换是治疗肝衰竭的有效办法,建议在肝功能好转后再开始使用碘131。

Objective To compare the different treatment methods for hyperthyroidism in patients with hyperthyroidism combined with severe liver injury so as to explore the effective treatment scheme.Methods Clinical data of 47 patients with hyperthyroidism combined with severe liver injury(20 cases of severe chronic hepatitis B and 27 cases of hepatic failure)who were hospitalized in our hospital and followed up from June 2003 to June 2017 were retrospectively analyzed.According to the clinical characteristics and treatment for hyperthyroidism,they were divided into non-anti-thyroid treatment group,anti-thyroid drug treatment group and iodine 131 group.Curative effects of different treatment were compared.Results In 20 patients with severe chronic hepatitis B,4 patients were not improved and 2 patients were ineffective in the non-anti-thyroid treatment group,12 patients in the antithyroid drug treatment group were all improved and 2 patients in the iodine 131 treatment group were both improved.The anti-thyroid drug treatment group was followed up for three months,and there was no side effect of anti-thyroid drugs such as severer liver injury and leukopenia.Among the patients with hepatic failure,10 patients died,2 patients were ineffective and 1 patient was improved in the anti-thyroid treatment group.In the anti-thyroid drug treatment group,9 patients were improved and 2 patients died.2 patients in the iodine 131 treatment group were both improved.The effective rate of the anti-thyroid drug treatment group and the iodine 131 group was higher than that of the nonanti-thyroid drug treatment group,and the difference was statistically significant(P<0.05).The levels of FT3,ALT and TB in the antithyroid drug treatment group and the iodine 131 treatment group were significantly lower than those in the non-antithyroid treatment group among patients with severe chronic viral hepatitis B and liver failure(P<0.05),while TSH levels were higher than the anti-thyroid treatment group(P<0.05).Conclusion The treatment of hyperthyroidism combined with severe hepatic damage is mainly to adopt different treatment methods for different causes.It is safe and effective for patients with severe liver injury to use anti-thyroid drugs on the basis of excluding liver injury caused by thyroid drugs.Combined with plasma exchange before and after iodine 131 treatment is an effective method for the treatment of liver failure.It is recommended to start using iodine 131 after liver function is improved.