甲状腺功能亢进症合并肝损害患者临床特点及影响肝损害发生的危险因素分析*

doi:10.3969/j.issn.1672-5069.2023.02.022

摘要/Abstract

摘要： 目的总结甲状腺功能亢进症(HT)合并药物性肝损害(DILI)患者临床特点,并探讨肝损害发生的危险因素。方法 2018年1月～2022年5月我院收治的HT患者216例,给予HT患者甲硫咪唑治疗,给予DILI患者葡醛内酯片治疗。常规检测血清血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)水平。结果在诊治过程中,发生肝损害102例(47.2%);肝损害组年龄、饮酒史比例、合并糖尿病比例、甲硫咪唑剂量大比例、血清FT3和FT4水平分别为(49.5±10.7)岁、44.1%、31.4%、62.8%、(19.0±5.8)pmol/L和(60.4±18.4)pmol/L,显著大于或高于HT组【分别为(44.0±14.5)岁、30.7%、6.1%、21.0%、(16.6±4.2)pmol/L和(32.3±9.8)pmol/L,P<0.05】;其中合并糖尿病【OR:1.8(95%CI:1.1～2.8)】、应用甲硫咪唑大剂量【OR:1.6(95%CI:1.0～2.4)】和高血清FT4水平【OR:1.6(95%CI:1.2～2.1)】是患者发生肝损害的独立危险因素(P<0.05);治疗后,HT合并肝损害患者血清FT3和FT4水平分别为(15.9±4.7)pmol/L和(40.1±12.5)pmol/L,显著低于治疗前【分别为(20.6±7.3)pmol/L和(70.5±23.3)pmol/L,P<0.05】,血清ALT和AST水平分别为(23.5±4.8)U/L和(29.1±6.2)U/L,显著低于治疗前【分别为(88.9±26.4)U/L和(64.6±18.7)U/L,P<0.05】。结论了解HT患者发生DILI的常见原因有助于做好预防工作,合理应用药物治疗HT及其合并症,以减少DILI的发生。

关键词: 甲状腺功能亢进症, 药物性肝损伤, 临床特点, 危险因素

Abstract: Objective This study aimed at summarizing the clinical features and risk factors of liver injuries in patients with hyperthyroidism (HT). Methods 216 patients with HT were encountered in our hospital between January 2018 and May 2022, and all took methimazole orally. The patients with drug-induced liver injuries (DILI) were treated by liver-protecting medicines. Serum free triiodothyronine (FT3), free thyroxine (FT4), alanine aminotransferase (ALT) and aspartate transaminase (AST) levels were routinely obtained. Results During the process of clinical management, the DILI was found in 102 cases (47.2%); the age, percentage of alcohol-taking, concomitant diabetes, large dose of methimazole administration, high serum FT3 and FT4 levels in patients with HT and DILI were (49.5±10.7)yr, 44.1%, 31.4%, 62.8%,(19.0±5.8)pmol/L and (60.4±18.4)pmol/L, significantly older or higher than[(44.0±14.5)yr, 30.7%, 6.1%, 21.0%, (16.6±4.2)pmol/L and (32.3±9.8)pmol/L, respectively, P<0.05] in 114 patients without DILI; the multivariate Logistic analysis showed that the concomitant diabetes[OR:1.8(95%CI:1.1-2.8)], large dose of methimazole administration [OR:1.6(95%CI:1.0-2.4)] and high serum FT4 level[OR:1.6(95%CI:1.2-2.1)] were all the independent risk factors for the occurrence of DILI (P<0.05); after treatment, serum FT3 and FT4 levels in patients with HT and DILI were (15.9±4.7)pmol/L and (40.1±12.5)pmol/L, both much lower than[(20.6±7.3)pmol/L and (70.5±23.3)pmol/L, respectively, P<0.05] before treatment, and serum ALT and AST levels were (23.5±4.8)U/L and (29.1±6.2)U/L, both much lower than[(88.9±26.4)U/L and (64.6±18.7)U/L, P<0.05] at the time of DILI diagnosed. Conclusion The clinicians should take the precipitating factors of DILI into consideration in patients with HT, and prescribe carefully medicines for them to decrease the incidence of DILI.

Key words: Hyperthyroidism, Drug-induced liver damage, Clinical feature, Risk factors

张彦, 夏文芳, 杨小雷, 王黎, 金进. 甲状腺功能亢进症合并肝损害患者临床特点及影响肝损害发生的危险因素分析^*[J]. 实用肝脏病杂志, 2023, 26(2): 238-241.

Zhang Yan, Xia Wenfang, Yang Xiaolei, et al.. Clinical features and risk factors of liver injuries in patients with hyperthyroidism[J]. Journal of Practical Hepatology, 2023, 26(2): 238-241.

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甲状腺功能亢进症合并肝损害患者临床特点及影响肝损害发生的危险因素分析^*

Clinical features and risk factors of liver injuries in patients with hyperthyroidism

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