甲状腺功能亢进合并肝损伤的临床特征

Causes and clinical characteristics of liver injury in 113 hyperthyroidism patients

目的探讨甲状腺功能亢进(HT)合并肝损伤患者的原因,分析其临床特征。方法回顾性分析南华大学附属中心医院2019年5月至2023年5月收治的113例HT患者的临床资料,根据患者是否合并肝损伤,分为合并肝损伤组(66例)与未合并肝损伤组(47例)。比较2组患者的临床指标、肝功能指标、甲状腺功能指标及并发症发生率。结果合并肝损伤组患者年龄、病程、基础代谢率分别为(44.7±5.7)岁、(4.4±1.3)年、(33.5±10.5)%,未合并肝损伤组分别为(36.5±5.2)岁、(2.4±0.7)年、(26.1±8.8)%,差异有统计学意义(P<0.05)。合并肝损伤组患者的AST、ALT、GGT、ALP、TBil分别为(96.6±28.4)U/L、(113.2±35.5)U/L、(71.2±9.3)U/L、(162.8±34.3)U/L、(33.5±8.8)μmol/L,未合并肝损伤组分别为(43.8±13.5)U/L、(47.8±16.8)U/L、(33.3±7.5)U/L、(75.3±21.7)U/L、(17.4±5.3)μmol/L,差异有统计学意义(P<0.05)。合并肝损伤组患者的游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)、四碘甲状腺原氨酸(T4)水平分别为(19.3±6.4)pmol/L、(86.7±25.3)pmol/L、(7.8±2.1)nmol/L、(253.7±19.5)nmol/L,未合并肝损伤组分别为(13.7±4.1)pmol/L、(35.6±11.2)pmol/L、(5.4±1.8)nmol/L、(216.8±17.8)nmol/L,差异有统计学意义(P<0.05)。合并肝损伤组患者的并发症总发生率为14.9%(7/47),未合并肝损伤组为33.3%(22/66),差异有统计学意义(P<0.05)。结论年龄大、病程长及基础代谢率差的HT患者更易发生肝损伤,HT合并肝损伤患者肝功能与甲状腺功能更差,临床并发症更多。

Objective To investigate the underlying causes and delineate the clinical features of injury in patients with hyperthyroidism(HT).Methods A retrospective analysis was conducted on the clinical data of 113 HT patients admitted to the Central Hospital of Nanhua University from May 2019 to May 2023.Patients were categorized into two groups:those with liver injury(66 cases)and those without(47 cases),Comparative analysis covered clinical indicators,liver and thyroid function parameters and complication rates between the groups.Results In this study,the liver injury group showed higher average age(44.7±5.7 years vs.36.5±5.2 years),longer disease duratic(4.4±1.3 years vs.2.4±0.7 years),and elevated basal metabolic rate(33.5±10.5%vs.26.1±8.8%),with all differences reaching statistical significant(P<0.05).Liver function tests revelaed markedly elevated levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),glutamyltransferase(GGT),alkaline phosphatase(ALP),and total bilirubin(TBiL)in the liver injury group compraed to controls,with values of(96.6±28.4)U/L vs.(43.8±13.5)U/L,(113.2±35.5)U/L vs.(47.8±16.8)U/L,(71.2±9.3)U/L vs.(33.3±7.5)U/L,(162.8±34.3)U/L vs.(75.3±21.7)U/L,(33.5±8.8)μmol/L vs.(17.4±5.3)μmol/L,repectively,indicating significant liver dysfunction(P<0.05).Thyroid fucntion tests also showed significant differences,with free triiodothyronine(FT3),free thyroxine(FT4),total triiodothyronine(TT3),and tetraiodothyronine(T4)levels all higher in the liver injury group[(19.3±6.4)pmol/L vs.13.7±4.1)pmol/L,(86.7±25.3)pmol/L vs.(35.6±11.2)pmol/L,(7.8±2.1)nmol/L vs.(5.4±1.8)nmol/L,(253.7±19.5)nmol/L vs.(216.8±17.8)nmol/L],highlighting the impact of liver injurt on thyroid fuction(P<0.05).Furthermore,the total complication rate was significantly higher in the liver injury group(33.3%)compared to the uncomplicated liver injury group(14.9%),underscoring the clinical relevance of liver injurt in hyperthyroidism management(P<0.05).Conclusion HT patients,those with prolonged disease duration,and those exhibitaing reduced basal metabolic rates demonstrated a higher susceptibility to liver injury.HT individuals presenting with concurrent liver damgae exhibit notably poorer liver and thyroid functions and face a higher incidence of clinical complications.These findings underscore the importance of early diagnosis and timely intervention,emphasizing the necessity for targeted symptomatic treatment to mitigate the adverse outcomes associated with HT and liver injury.