甲状腺功能亢进性肝损害与甲巯咪唑继发性肝损害的临床比较研究

目的分析甲状腺功能亢进症(简称甲亢)性肝损害患者的肝功能与甲状腺功能的相关性,探讨抗甲亢药物甲巯咪唑所致肝损害患者的临床特征及其引起肝损害的相关因素。方法纳入甲亢性肝病患者54例(甲亢性肝损害组)和初诊未治的无肝损害甲亢患者33例(甲亢无肝损害组),收集两组患者用药前的一般资料和临床资料(甲状腺功能和肝功能),分析甲亢性肝损害的相关因素;将同期抗甲亢药物甲巯咪唑致肝损害患者(27例)根据肝功能指标分为肝细胞型组(7例)、胆汁淤积型组(12例)和混合型组(8例),收集其一般资料和临床资料(甲状腺功能和肝功能)并比较。结果甲亢性肝损害组患者治疗前的ALT、AST、碱性磷酸酶(ALP)、谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)、游离三碘甲腺原氨酸(FT 3)、游离甲状腺激素(FT 4)和促甲状腺激素受体抗体(TRAb)水平明显高于甲亢无肝损害组(P<0.05),两组患者ALT、ALP、γ-GT水平均与FT 3、FT 4、TRAb水平呈明显正相关(P<0.05)。肝细胞型组、胆汁淤积型组和混合型组患者的年龄、用药时间、ALT、ALP比较差异均有统计学意义(P<0.05)。结论甲亢患者甲状腺功能异常的严重程度可能与其肝损害相关;抗甲亢药物甲巯咪唑引起的肝损害类型可能与患者年龄、病程及用药时间有关。

Clinical comparative analysis of hyperthyroidism with hepatic dysfunction and methimazole induced liver injury

Objective To analyze the correlations of hepatic function and thyroid function in hyperthyroidism patients with hepatic dysfunction,explore the clinical characteristics in antithyroid drug methimazole related hepatotoxicity and its related factors.Methods A total of 54 patients with hyperthyroidism liver disease(hyperthyroidism liver damage group)and 33 patients with no treatment after initial diagnosis without liver damage hyperthyroidism(hyperthyroidism without liver damage group)were included.The general and clinical data(thyroid and liver function)of the two groups were collected and the related factors to hyperthyroidism with liver dysfunction were analyzed.Twenty-seven patients with antithyroid drug induced liver injury at the same time were also included.They were divided into hepatocellular hepatotoxicity group(7 cases),cholestatic hepatotoxicity group(12 cases)and mixed hepatotoxicity group(8 cases)according to the liver function index,and to compare their general and clinical data(thyroid and liver function).Results The levels of ALT,AST,alkaline phosphatase(ALP),γ-glutamyl transpeptadase(γ-GT),total bilirubin(TBIL),free triiodomethylamine(FT 3),free thyroid hormone(FT 4)and thyrotrophin receptor antibody(TRAb)before the treatment in patients with hyperthyroidism liver damage group were significantly higher than those in hyperthyroidism without liver damage group(P<0.05).The levels of ALT,ALP,γ-GT were correlated positively to FT 3,FT 4 and TRAb(P<0.05).There were statistically significant differences in age,time of application of antithyroid drugs,levels of ALT and ALP among hepatocyte,cholestasis and mixed hepatotoxicity groups(P<0.05).Conclusion The severity of thyroid dysfunction may be associated with liver damage in patients with hyperthyroidism.The type of liver damage caused by the antithyroid drug methimidazole maybe related to the age,course of disease and duration of medication in patients.