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目的:分析高原藏族聚居区慢性乙肝(CHB)患者三碘甲状腺原氨酸(T3)/四碘甲状腺原氨酸(T4)水平与肝功能及HBV-DNA的相关性。方法:选取2016年6月至2018年6月本院收治的HBsAgn ＋CHB感染者420例为观察组，分为藏族观察组300例，汉族观察组120例，根据HBV-DNA水平将藏族观察组分为A、B、C三组。选取同期健康体检者为对照组，藏族对照组220例，汉族对照组120例。采用荧光定量PCR(qRT-PCR)法检测HBV-DNA表达水平，利用化学发光法检测血清促甲状腺激素(TSH)、T3、T4、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)水平，利用全自动生化仪及配套试剂盒检测血清丙氨酸转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆汁酸(TBA)水平，利用血凝仪检测凝血酶原时间(PT)，采用全自动化学发光仪检测HBsAg、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(C-Ⅳ)、层粘连蛋白(LN)、透明质酸酶(HAC)水平。n 结果:藏族和汉族CHB患者血清ALT、AST、HBV-DNA、TBA、PT、LN、PC-Ⅲ、C-Ⅳ、HAC水平均明显高于藏族和汉族对照组；藏族CHB患者血清AST、PC-Ⅲ、HAC、LN水平明显高于汉族CHB患者(n P<0.05)，PT、TBA明显低于汉族CHB患者(n P<0.05)；藏族CHB患者血清ALT、AST、PT、TBA、C-Ⅳ、PC-Ⅲ、HAC、LN水平随着CHB患者血清HBV-DNA水平升高而升高(n P0.05)，随着藏族患者血清HBV-DNA水平升高，B、C组患者血清T3水平、T3/T4比值明显低于藏族对照组(n P<0.05)，T4水平明显高于藏族对照组(n P0.05)；Pearson检验结果显示，藏族CHB患者血清T3水平、T3/T4比值与ALT、AST、PT、TBA、LN、HBV-DNA、C-Ⅳ、HAC水平呈负相关(n P<0.05)；藏族CHB患者血清T4水平与ALT、AST、PT、TBA、LN、HBV-DNA、C-Ⅳ、HAC水平呈正相关(n P<0.05)。n 结论:藏族CHB患者血清T3/T4比值降低，与汉族CHB患者比较无明显差异，且与血清HBV-DNA水平呈负相关，提示CHB患者甲状腺激素水平可能与HBV感染引起的肝损伤有关。“,”Objective:To detect serum thyroid hormone level, HBV-DNA expression level and liver function index in patients with chronic hepatitis B (CHB) in plateau Tibetan inhabited areas, and to analyze their correlations.Methods:From June 2016 to June 2018, 420 patients with HBsAgn + CHB infection in our hospital were selected as the observation group, which was divided into Tibetan observation group (n n=300)and Han observation group (n n=120). According to the level of HBV-DNA, the observation group was divided into three groups: A, B and C group. The healthy people in the same period were selected as the control group, 220 cases in Tibetan control group and 120 cases in Han control group. The expression level of HBV-DNA was detected by fluorescence quantitative polymerase chain reaction (qRT-PCR). Serum levels of thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) were measured by chemiluminescence. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bile acid (TBA) levels were measured by automatic biochemical analyzer and kit; the prothrombin time (PT) was measured by hemagglutination analyzer.n Results:The levels of serum ALT, AST, HBV-DNA, TBA, PT, laminin (LN), procollagen-Ⅲ (PC-Ⅲ), collagen-Ⅳ (C-Ⅳ) and hyaluronidase (HAC) in Tibetan and Han observation group were significantly higher than those in Tibetan and Han control group (n P<0.05). The level of serum HAC in Tibetan patients with CHB was significantly higher than that in Han CHB patients (n P<0.05); the level of serum ALT, AST, PT, TBA, C-Ⅳ, PC-Ⅲ, HAC, LN increased with the level of serum HBV-DNA in patients with CHB (n P0.05). With the increase of serum HBV-DNA level in Tibetan patients, serum T3 level and T3/T4 ratio in group B and C were significantly lower than those in the control group (n P<0.05), T4 level was significantly higher than that in the control group (n P0.05). The results of Pearson test showed that serum T3 level and T3/T4 ratio were negatively correlated with ALT, AST, PT, TBA, LN, HBV-DNA, C-Ⅳ and HAC levels in Tibetan CHB patients (n P<0.05); serum T4 level was positively correlated with ALT, AST, PT, TBA, LN, HBV-DNA, C-Ⅳ and HAC levels in Tibetan CHB patients (n P<0.05).n Conclusions:Thyroid hormones TSH, T3, and T4 levels in CHB patients in plateau Tibetan inhabited areas are decreased significantly with the increase of HBV-DNA levels, and they are negatively correlated with ALT, AST, PT and TBA levels, suggesting that HBV infection may cause liver injury to some extent, and then affect the level of thyroid hormone.