CAJ | 학술논문

目的探讨甲状腺功能亢进症(甲亢)患儿甲亢性肝损害的发生率及相关因素.方法将393例甲亢患儿分为甲亢性肝损害组(174例)和甲亢肝功能正常组(219例),对2组患儿性别、年龄、甲状腺疾病家族史、病程、肝功能及甲状腺功能指标等进行回顾性分析.结果儿童甲亢性肝损害的发生率为44.3％(174/393例),甲亢性肝损害最常见的异常指标是丙氨酸氨基转移酶(ALT)升高(147例,占88.5％).甲亢性肝损害组与甲亢肝功能正常组的性别、年龄、甲状腺疾病家族史、病程、甲状腺过氧化物酶抗体水平、甲状腺球蛋白抗体水平比较差异均无统计学意义(P均＞0.05);甲亢性肝损害组的游离三碘甲状腺原氨酸水平和游离甲状腺素水平均显著高于甲亢肝功能正常组(Z=-7.90,P=0.000;Z=-8.80,P=0.000),而促甲状腺激素水平显著低于甲亢肝功能正常组(Z=-4.60,P=0.000).甲巯咪唑治疗后,甲亢性肝损害组的肝功能与治疗前比较均显著好转:ALT(Z=-14.90,P=0.000),天冬氨酸转氨酶(Z=-5.30,P=0.000)、γ转肽酶(Z=-5.50,P=0.000)、碱性磷酸酶(Z=-5.90,P=0.000)、总胆红素(Z=-5.50,P=0.000)、结合胆红素(Z=-4.60,P=0.000)、未结合胆红素(Z=-4.60,P=0.000).结论儿童甲亢易导致肝损害,甲亢性肝损害与甲状腺激素水平有关;肝损害最常见的异常指标是ALT升高;肝损害通常是短暂的、轻度的;肝功能恢复与甲状腺功能的恢复一致.
목적 탐토갑상선공능항진증(갑항)환인갑항성간손해적발생솔급상관인소.방법 장393례갑항환인분위갑항성간손해조(174례)화갑항간공능정상조(219례),대2조환인성별、년령、갑상선질병가족사、병정、간공능급갑상선공능지표등진행회고성분석.결과 인동갑항성간손해적발생솔위44.3％(174/393례),갑항성간손해최상견적이상지표시병안산안기전이매(ALT)승고(147례,점88.5％).갑항성간손해조여갑항간공능정상조적성별、년령、갑상선질병가족사、병정、갑상선과양화물매항체수평、갑상선구단백항체수평비교차이균무통계학의의(P균＞0.05);갑항성간손해조적유리삼전갑상선원안산수평화유리갑상선소수평균현저고우갑항간공능정상조(Z=-7.90,P=0.000;Z=-8.80,P=0.000),이촉갑상선격소수평현저저우갑항간공능정상조(Z=-4.60,P=0.000).갑구미서치료후,갑항성간손해조적간공능여치료전비교균현저호전:ALT(Z=-14.90,P=0.000),천동안산전안매(Z=-5.30,P=0.000)、γ전태매(Z=-5.50,P=0.000)、감성린산매(Z=-5.90,P=0.000)、총담홍소(Z=-5.50,P=0.000)、결합담홍소(Z=-4.60,P=0.000)、미결합담홍소(Z=-4.60,P=0.000).결론 인동갑항역도치간손해,갑항성간손해여갑상선격소수평유관;간손해최상견적이상지표시ALT승고;간손해통상시단잠적、경도적;간공능회복여갑상선공능적회복일치.
Objective To explore the morbidity and the related clinical factors of hepatic dysfunction in children with hyperthyroidism.Methods Totally 393 children with hyperthyroidism were divided into 2 groups:hyperthyroidism with hepatic dysfunction group(174 cases) and hyperthyroidism with normal liver function group(219 cases).The gender,age,family history of thyroid disease,duration of disease,liver function and thyroid function indicators were retrospectively analyzed in the 2 groups.Results The morbidity of hepatic dysfunction in children with hyperthyroidism was 44.3％ (174/393 cases),and the most common abnormal hepatic function parameter was the increase of alanine aminotransferase(ALT),which accounted for 88.5％ (147 cases).There were no significant differences of gender,age,family history of thyroid disease,duration of the disease,or levels of thyroid peroxidase antibodies and thyroglobulin antibodies between the hepatic dysfunction abnormal group and liver function normal group (all P ＞ 0.05).Free triiodothyronine and free thyroxine of hepatic dysfunction abnormal group were significantly higher than those in liver function normal group (Z =-7.90,P =0.000 ; Z =-8.80,P =0.000) ; and thyroid stimulating hormone of hepatic dysfunction abnormal group was significantly lower than that in liver function normal group (Z =-4.60,P =0.000).Liver functions after treatment with Methimazole of the hyperthyroidism cases were all significantly improved:ALT(Z =-14.90,P =0.000),aspartate aminotransterase(Z =-5.30,P =0.000),γ-glutamyltransferse (Z =-5.50,P =0.000),alkaline phosphatase (Z =-5.90,P =0.000),total bilirubin (Z =-5.50,P =0.000),direct bilirubin (Z =-4.60,P =0.000),indirect bilirubin (Z =-4.60,P =0.000).Conclusions Hepatic dysfunction caused by hyperthyroidism in children is common and correlated with thyroid function.Elevation of ALT is the most common abnormal hepatic function parameter.The hepatic dysfunction is usually transient and mild and is to be normal with normalized thyroid function.