自身免疫性肝病患者甲状腺功能变化及其对治疗应答的影响*

doi:10.3969/j.issn.1672-5069.2023.04.014

摘要/Abstract

摘要： 目的研究自身免疫性肝病(AILD)患者甲状腺激素水平变化及其对治疗应答率的影响。方法 2016年5月～2022年9月安徽医科大学第二附属医院收治的自身免疫性肝炎(AIH)患者52例、原发性胆汁性胆管炎(PBC)患者34例和AIH-PBC重叠综合征(OS)患者46例,按照指南要求,给予每种疾病患者规范的治疗。另选52例健康人作为对照组。采用化学发光免疫分析法检测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、T3、T4、促甲状腺激素(TSH)、抗促甲状腺素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TgAb)、甲状腺素结合球蛋白(TBG)和甲状腺球蛋白(Tg)。结果 AIH组、PBC组和OS组血清FT3水平分别为4.5(3.9,5.0)pmol/L、4.4 (4.0,4.5)pmol/L和4.1(3.7,4.7)pmol/L,血清FT4水平分别为14.8(13.0,16.5)pmol/L、14.6(13.0,16.0) pmol/L和14.8(13.1,15.9)pmol/L,均显著低于健康人【分别为4.8(4.5,5.0)pmol/L和15.7(14.5,16.9)pmol/L,P<0.05】;OS组血清TSH水平为3.4(2.1,6.4)mIU/L,显著高于健康人【2.8(2.0,3.3)mIU/L,P<0.05】;AIH组血清TRAb、TGAb、TPOAb、TBG和Tg阳性率分别为5.4%、21.6%、29.7%、8.1%和0.0%,PBC组分别为6.9%、13.8%、17.2%、10.3%和3.4%,OS组分别为12.5%、18.8%、21.9%、0.0%和3.1%,三组间无显著性差异(P>0.05);AIH组甲状腺功能减退症和亚临床甲状腺功能减退症发生率分别为9.6%和13.5%,PBC组分别为20.6%和23.5%,OS组分别为6.5%和30.4%,也无显著性差异(P>0.05);在治疗6个月末,AIH、PBC和OS患者治疗应答者分别为21例(41.2%)、25例(73.5%)和12例(26.7%),合并与未合并甲状腺疾病患者治疗应答率无显著性差异(分别为28.6%对45.9%、66.7%对81.3%和38.9%对(18.5%,均P>0.05)。结论 AIH、PBC、OS三组中血清FT3、FT4水平明显降低,血清TSH水平明显升高。是否合并甲状腺疾病对AIH、PBC、OS三种疾病的治疗应答无明显影响。

关键词: 自身免疫性肝病, 甲状腺激素, 抗甲状腺抗体, 治疗应答

Abstract: Objective The aim of this study was to assess the changes of thyroid hormone in patients with autoimmune liver diseases (AILD). Methods 52 patients with autoimmune hepatitis (AIH), 34 patients with primary biliary cholangitis (PBC) and 46 patients with AIH-PBC overlap syndrome (OS) were admitted to the Second Affiliated Hospital, Anhui Medical University between May 2016 and September 2022, and 52 healthy persons were selected as control. Serum free triiodothyronine (FT3), free thyroxine (FT4), T3, T4, thyroid stimulating hormone (TSH), thyrotrophin receptor antibody (TRAb), thyroid peroxidase antibody (TPOAb), anti-thyroglobulin antibody (TgAb), thyroxine-binding globulin (TBG) and thyroglobulin (Tg) were detected. Results Serum FT3 levels in patients with AIH, with PBC and with OS were 4.5(3.9, 5.0)pmol/L, 4.4 (4.0, 4.5)pmol/L and 4.1(3.7, 4.7)pmol/L, serum FT4 levels were 14.8(13.0, 16.5)pmol/L, 14.6(13.0, 16.0) pmol/L and 14.8(13.1, 15.9)pmol/L, all significantly lower than[4.8(4.5, 5.0)pmol/L and 15.7(14.5, 16.9)pmol/L, respectively, P<0.05] in healthy individuals; serum TSH level in patients with OS was 3.4(2.1, 6.4)mIU/L, much higher than[2.8(2.0, 3.3)mIU/L, P<0.05] in healthy control; the positive rates of serum TRAb, TGAb, TPOAb, TBG and Tg in patients with AIH were 5.4%, 21.6%, 29.7%, 8.1% and 0.0%, in patients with PBC were 6.9%, 13.8%, 17.2%, 10.3% and 3.4%, and in patients with OS were 12.5%, 18.8%, 21.9%, 0.0% and 3.1%, all not significantly different among them (P>0.05); the incidences of hypothyroidism and subclinical hypothyroidism in patients with AIH were 9.6% and 13.5%, in patients with PBC were 20.6% and 23.5%, and in those with OS were 6.5% and 30.4%, also not significantly different among them (P>0.05); at the end of six month treatment, 21 patients(41.2%) with AIH, 25 patients (73.5%) with PBC and 12 patients (26.7%) with OS responded to treatment, and there were no significant differences as respect to the response rates between patients with and without thyroid diseases(28.6% vs. 45.9%, 66.7% vs. 81.3% and 38.9% vs. 18.5%, respectively, all P>0.05). Conclusion Serum FT3 and FT4 levels decrease and serum TSH level increase in patients with AIH, PBC and OS, and the implication of concomitant thyroid diseases in this setting needs to be clarified.

Key words: Autoimmune liver diseases, Thyroid hormones, Anti-thyroid antibodies, Response

甄永利, 张亚飞, 张振华. 自身免疫性肝病患者甲状腺功能变化及其对治疗应答的影响^*[J]. 实用肝脏病杂志, 2023, 26(4): 508-511.

Zhen Yongli , Zhang Yafei , Zhang Zhenhua. Changes of thyroid hormone in patients with autoimmune liver diseases[J]. Journal of Practical Hepatology, 2023, 26(4): 508-511.

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自身免疫性肝病患者甲状腺功能变化及其对治疗应答的影响^*

Changes of thyroid hormone in patients with autoimmune liver diseases

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