慢加急性肝衰竭患者血清甲状腺激素水平变化及其与预后的关系

摘要

目的 探讨甲状腺激素在慢加急性肝衰竭(ACLF)患者血清中的水平变化及其对预后的影响.方法 分别测定45例ACLF患者及49例慢性乙型肝炎(CHB)患者血清中 FT3、FT4、TSH的表达水平,比较表达水平的差异,分析其与ACLF预后的关系.结果 ACLF患者血清FT3(2.16 ± 0.67)pmol/L及TSH(0.87 ± 0.82)IU/mL的表达水平显著低于CHB患者的(2.81 ± 0.88)pmol/L和(2.74 ± 2.33)IU/mL.ACLF存活者的TSH的表达水平(1.12 ± 1.09)IU/mL显著高于死亡者的(0.58 ± 0.49)IU/mL(P<0.05).Spearman相关性分析发现,TSH与总胆红素(TBil)、MELD评分呈显著负相关(TBil:r= -0.508,M ELD:r= -0.467,P<0.05),FT3与TBil亦呈显著负相关(r= -0.399,P<0.05).结论血清甲状腺激素水平可以作为ACLF患者病情轻重程度的指标,并可以预测ACLF患者的预后.%Objective To investigate the expression of serum thyroid hormones in acute on chronic liver failure (ACLF)patients and its correlation with prognosis.Methods Levels of serum free triiodothyronine(FT3),free thyroxin (FT4)and thyroid stimulating hormone(TSH)in ACLF patients(n=45)and chronic hepatitis B(CHB)patients(n=49) were detected and their effect on prognosis was analyzed.Results Compared with CHB patients,ACLF patients showed lower levels of FT3(2.16 ± 0.67 vs.2.81 ± 0.88,P<0.05)and TSH(0.87 ± 0.82 vs.2.74 ± 2.33,P<0.05).In ACLF patients,serum TSH level in survivors was significant higher than that in non-survivors(1.12 ± 1.09 vs.0.58 ± 0.49,P<0.05).Spearman correlation analysis showed that TSH level was negatively correlated with total bilirubin(TBil)and model for end-stage liver disease score(r= 0.508 and r= 0.467,both P< 0.05).Moreover,FT3 was significantly negatively correlated with TBil(r= -0.399,P<0.05).Conclusion Expression of serum thyroid hormones could be an index for severity in ACLF patients and a valuable predictor for ACLF prognosis.