Graves病患者促甲状腺激素受体抗体与肝功能指标的关系

Correlation between thyrotropin receptor antibody and liver function tests in patients with Graves’disease

目的探讨Graves病患者促甲状腺激素受体抗体(TRAb)与肝功能各指标间的关系。方法选取2014年1月-2018年6月南京中医药大学附属医院内分泌科收治的Graves病患者231例。其中,男性53例,女性178例。检测所有患者TRAb、甲状腺功能及肝功能指标;通过非参数检验、Logistic回归模型分析及ROC曲线,分析Graves病患者肝功能异常指标与TRAb的关联性。结果231例患者中,有58.4%患者存在不同程度的肝功能受损;TRAb水平四分位分组后发现,随着TRAb水升高,游离三碘甲腺原氨酸(FT3)和游离甲状腺素(FT4)上升(P<0.05),而肝功能指标中只有碱性磷酸酶(ALP)的组间比较,差异有统计学意义(P<0.05);在控制性别、年龄、FT3、FT4和其他肝功能指标后,Logistic回归模型分析结果显示,随着TRAb水平升高,血清ALP升高的相对危险度增加(P<0.05),TRAb水平四分位的OlR值达3.284(95%CI:1.221,8.832);ROC曲线分析显示,当TRAb≥11.96 IU/L时,ALP升高的危险增加。结论TRAb水平是Graves病患者ALP升高的影响因素。

Objective To investigate the relationship between thyrotropin receptor antibody(TRAb)and liver function in patients with Graves’disease.Methods From January 2014 June 2018,231 newly diagnosed patients with Graves’disease were collected,including 178 female patients and 53 male patients.TRAb,thyroid function and liver function were measured in all patients.The correlation between abnormal liver function and TRAb in Graves’disease was analyzed by nonparametric test,Logistic binary regression analysis and ROC curve.Results About 58.4%of the newly diagnosed patients with Graves’disease had different degrees of liver function impairment.The levels of FT3 and FT4 increased significantly with the elevation of TRAb(P<0.05),while only ALP also rised among indexes of liver function(P<0.05).After adjusting of age,sex,FT3,FT4 and other liver function indicators,Logistic regression analysis showed that with the increase of TRAb level,only the relative risk of elevated serum ALP increased(P<0.05),and the OR value of the fourth fraction of TRAb reached 3.284(95%CI:1.221,8.832);while ALT,AST,GGT,TBil and DBil did not show direct correlation with the level of TRAb;ROC curve calculation showed that when TRAb was greater than 11.96 IU/L,the risk of elevation of ALP was increased.Conclusion TRAb is an independent factor influencing the elevation of ALP in liver function test in newly diagnosed Graves’disease.