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目的探讨Graves病患者并发甲状腺功能亢进症(甲亢)性肝功能损害的临床特征及相关因素。方法 230例Graves病患者中,并发甲亢性肝功能损害105例(A组),肝功能正常125例(B组),初诊患者98例(C组),使用抗甲状腺药物治疗在半年以内且未同时使用保肝药物者132例(D组)。检测患者肝功能、血清甲状腺激素及自身抗体水平,分析甲亢性肝功能损害的临床特点及相关因素。结果 A组ALT、AST、γ谷氨酰转肽酶(GGT)、TBil、ALP、FT_3、FT_4、促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)水平均高于B组(P<0.05),而两组甲状腺球蛋白抗体(TGAb)比较差异无统计学意义(P>0.05)。A组患者ALT、AST、GGT与FT_3、FT_4、TRAb、TPOAb均呈正相关(P<0.05)。C组甲亢性肝功能损害的发生率高于D组(66.3%vs.30.3%)(P<0.05)。D组患者中,抗甲状腺药物治疗时间在12周内和12周以上并发甲亢性肝功能损害患者分别为43例(63.2%)和29例(45.3%),比较有统计学差异(P<0.05)。结论 Graves病患者并发甲亢性肝功能损害较常见,最常见的异常指标是ALP和ALT。临床上对于TRAb和TPOAb滴度高的Graves病患者应重视肝功能损害,必要时给予相应的预防和治疗。
Objective To investigate the clinical characteristics and related factors of Graves’ disease complicated with hyperthyroidism (Hyperthyroidism) liver dysfunction. Methods One hundred and twenty patients with Graves’ disease were complicated by hyperthyroidism, 105 cases of liver dysfunction (group A), 125 cases of normal liver function (group B), 98 cases of newly diagnosed patients (group C), anti-thyroid drug treatment within 6 months In the meantime, 132 cases of hepatoprotective drugs were used (group D). The liver function, serum thyroid hormones and autoantibodies were detected, and the clinical features and related factors of hyperthyroidism were analyzed. Results The levels of ALT, AST, GGT, TBil, ALP, FT_3, FT_4, TRAb and TPOAb in group A were all higher than those in group B (P <0.05), while there was no significant difference in TGAb between the two groups (P> 0.05). ALT, AST and GGT in group A were positively correlated with FT_3, FT_4, TRAb and TPOAb (P <0.05). The incidence of hyperthyroidism in C group was higher than that in D group (66.3% vs.30.3%) (P <0.05). In group D, 43 patients (63.2%) and 29 patients (45.3%) had anti-thyroid drug treatment within 12 weeks and over 12 weeks, respectively, with statistical significance (P <0.05 ). Conclusions Patients with Graves’ disease complicated by hyperthyroidism are more common liver dysfunction. The most common abnormalities are ALP and ALT. Clinically, patients with Graves disease who have high titers of TRAb and TPOAb should pay attention to liver damage and give appropriate prevention and treatment if necessary.