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目的分析血清TSH、FT3、FT4水平与肝硬化肝功能损害程度的相关性。方法对我院于2013年7月至2015年6月收治的肝硬化患者120例和门诊体检为无异常的健康者120例的临床资料进行回顾性分析。对比健康人和肝硬化组患者血清促甲状腺激素(TSH)、血清游离三碘甲状腺原氨酸(FT3)和血清游离甲状腺素(FT4)水平和肝功能指标白蛋白(ALB)、总胆红素(TBIL)水平,将肝硬化组患者按照Child-Pugh改良分级法分为A、B、C三组,对比三组患者血清TSH、FT3和FT4水平以及肝功能指标ALB和TBIL水平。结果肝硬化组患者血清TSH水平为(8.64±1.22)m IU/L,高于健康人(3.96±0.67)m IU/L(t=36.833,P=0.000),FT3和FT4水平分别(3.16±0.51pmol/L、10.29±1.43pmol/L),均低于健康人(6.09±0.94 pmol/L、19.20±3.42 pmol/L)(t值分别为30.013、26.330,均P=0.000)。肝硬化组患者血清ALB水平为(29.64±3.61)g/L,低于健康人(45.62±5.40)g/L(t=26.950,P=0.000),血清TBIL水平为(45.96±4.19)μmol/L,高于健康人(13.52±2.16)μmol/L(t=75.385,P=0.000)。肝功能分级越高,患者血清TSH随之升高,但组间相比,差异无显著性(F=2.262,P=0.159),FT3和FT4水平随肝功能分级升高而降低,组间相比,差异具有显著性(F值分别为7.737和5.286,P值分别为0.029和0.037)。肝功能分级越高,患者血清ALB越低,组间相比差异具有显著性(F=8.629,P=0.025),血清TBIL水平随肝功能分级升高而升高,组间相比差异具有显著性(F=8.854,P=0.024)。TSH、FT3和FT4水平与血清ALB和TBIL水平的Pearson相关分析显示TSH水平和肝硬化组肝功能指标ALB和TBIL无相关性(r=-0.096,P=0.296;r=0.115,P=0.159),FT3和FT4水平与肝功能指标ALB呈正相关(r=-0.468,P=0.031;r=0.391,P=0.045),和TBIL水平呈负相关(r=-0.491,P=0.029;r=-0.435,P=0.036)。结论肝硬化患者肝功能损害程度越高,血清甲状腺激素FT3和FT4的水平越低,且与FT3和FT4水平呈负相关,肝功能受损会影响患者血清TSH水平,但无线性相关性。
Objective To analyze the correlation between the levels of serum TSH, FT3 and FT4 and the degree of hepatic dysfunction in cirrhosis. Methods The clinical data of 120 patients with cirrhosis who were admitted to our hospital from July 2013 to June 2015 and 120 healthy persons without outpatients were retrospectively analyzed. Thyroid hormone (TSH), serum free triiodothyronine (FT3) and serum free thyroxine (FT4) and liver function indicators albumin (ALB), total bilirubin (TBIL). The patients with liver cirrhosis were divided into three groups according to Child-Pugh’s modified grading method. The levels of serum TSH, FT3 and FT4 and the indexes of ALB and TBIL were compared among the three groups. Results The level of serum TSH in patients with cirrhosis was (8.64 ± 1.22) m IU / L, which was significantly higher than that in healthy people (3.96 ± 0.67) mU / L (t = 36.833, (6.09 ± 0.94 pmol / L, 19.20 ± 3.42 pmol / L) (t = 30.013, 26.330, all P = 0.000). The level of serum ALB was (29.64 ± 3.61) g / L in cirrhotic patients, which was lower than that in healthy people (45.62 ± 5.40) g / L (t = 26.950, L, higher than healthy people (13.52 ± 2.16) μmol / L (t = 75.385, P = 0.000). The higher the grade of liver function, the higher the level of serum TSH in patients, but there was no significant difference between groups (F = 2.262, P = 0.159). FT3 and FT4 levels decreased with the increase of liver function. The differences were significant (F values were 7.737 and 5.286, P values were 0.029 and 0.037, respectively). The higher the grade of liver function, the lower the serum ALB in patients, the difference between groups was significant (F = 8.629, P = 0.025). The level of serum TBIL increased with the increase of liver function grade, and the difference was significant Sex (F = 8.854, P = 0.024). Pearson correlation analysis between TSH, FT3 and FT4 levels and serum ALB and TBIL levels showed no correlation between TSH levels and ALB and TBIL (r = -0.096, P = 0.296; r = 0.115, P = 0.159) , FT3 and FT4 levels were positively correlated with ALB of liver function (r = -0.468, P = 0.031; r = 0.391, P = 0.045) and negative correlation with TBIL (r = -0.491, 0.435, P = 0.036). Conclusions The higher the degree of liver damage is, the lower the levels of serum thyroid hormones FT3 and FT4 are, and there is a negative correlation between FT3 and FT4 levels. The impaired liver function may affect the level of serum TSH in patients with cirrhosis, but there is no linear correlation.