Vincken Stefanie, Reynaert Hendrik, Schiettecatte Johan, Kaufman Leon, Velkeniers Brigitte
a Department of Internal Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
b Department of Gastro-Enterology , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
Acta Clin Belg. 2017 Apr;72(2):85-90. doi: 10.1080/17843286.2016.1215641. Epub 2016 Aug 24.
The liver plays a central role in thyroid hormone metabolism, transport, and clearance. A normal function of both the thyroid gland and the liver is therefore necessary to maintain normal thyroid hormone levels and action. Data regarding thyroid function in patients with liver cirrhosis are scarce and variable. The most consistent finding is a decreased free triiodothyronine (fT3) level, which correlates with the severity of liver disease and has been proposed as a prognostic factor for liver-related complications.
To evaluate thyroid hormone values in patients with stable liver cirrhosis and to compare them with healthy controls without liver disease. We also assessed the prevalence of thyroid autoimmunity and whether liver function tests correlated with thyroid function.
We performed a prospective case-control study in an endocrinological setting. Twenty-nine patients with stable cirrhosis (20 males and 9 females, mean age 60.97 ± 7.17 years) were included in the case group and 50 healthy subjects (22 males and 28 females, mean age 61.70 ± 13.00 years) in the control group. We excluded patients with confounding factors known to influence thyroid function. Levels of serum thyroid-stimulating hormone (TSH), fT3, free thyroxine (fT4) and anti-TPO-antibodies (TPO-Ab) were measured. These thyroid hormone values were compared in both groups. Biochemical indices of liver function (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [AP], gamma-glutamyl transpeptidase [GGT], INR, total bilirubin, and albumin levels) were correlated with thyroid function tests.
fT3 en fT4 levels were significantly lower in patients with cirrhosis than in healthy subjects (p = 0.001 and 0.002, respectively). TSH levels were not statistically significantly different in the two groups. The level of TPO-Ab was not increased in patients with cirrhosis compared to healthy controls. fT3 correlated negatively with the Child-Pugh score.
These results indicate that, compared to healthy controls, patients with cirrhosis have decreased fT3 and fT4 levels and comparable TSH levels and may be consistent with findings of limited acquired central hypothyroidism as observed in the non-thyroidal illness syndrome (NTIS). fT3 levels correlated negatively with Child-Pugh score, a measure of severity of liver dysfunction. We did not find an increased prevalence of thyroid autoimmunity in these patients.
肝脏在甲状腺激素的代谢、运输和清除过程中起着核心作用。因此，甲状腺和肝脏的正常功能对于维持正常的甲状腺激素水平及作用至关重要。关于肝硬化患者甲状腺功能的数据稀少且存在差异。最一致的发现是游离三碘甲状腺原氨酸（fT3）水平降低，这与肝脏疾病的严重程度相关，并已被提议作为肝脏相关并发症的一个预后因素。
评估稳定期肝硬化患者的甲状腺激素值，并与无肝脏疾病的健康对照者进行比较。我们还评估了甲状腺自身免疫的患病率以及肝功能检查与甲状腺功能是否相关。
我们在一个内分泌环境中进行了一项前瞻性病例对照研究。病例组纳入了29例稳定期肝硬化患者（20例男性和9例女性，平均年龄60.97±7.17岁），对照组纳入了50名健康受试者（22例男性和28例女性，平均年龄61.70±13.00岁）。我们排除了已知会影响甲状腺功能的混杂因素患者。测量了血清促甲状腺激素（TSH）、fT3、游离甲状腺素（fT4）和抗甲状腺过氧化物酶抗体（TPO-Ab）的水平。对两组的这些甲状腺激素值进行了比较。肝功能的生化指标（天冬氨酸氨基转移酶[AST]、丙氨酸氨基转移酶[ALT]、碱性磷酸酶[AP]、γ-谷氨酰转肽酶[GGT]、国际标准化比值[INR]、总胆红素和白蛋白水平）与甲状腺功能检查相关。
肝硬化患者的fT3和fT4水平显著低于健康受试者（分别为p = 0.001和0.002）。两组的TSH水平在统计学上无显著差异。与健康对照相比，肝硬化患者的TPO-Ab水平未升高。fT3与Child-Pugh评分呈负相关。
这些结果表明，与健康对照相比，肝硬化患者的fT3和fT4水平降低，TSH水平相当，这可能与非甲状腺疾病综合征（NTIS）中观察到的有限获得性中枢性甲状腺功能减退的结果一致。fT3水平与Child-Pugh评分呈负相关，Child-Pugh评分是肝功能障碍严重程度的一个指标。我们在这些患者中未发现甲状腺自身免疫患病率增加。
