Wang Lin, Yu Wanyou, Cao Wukui, Lu Wei
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center of Digestive Diseases, Beijing, China.
Department of ICU, Tianjin City Second People's Hospital, Tianjin, China.
Oncotarget. 2017 Jun 29;8(40):67821-67828. doi: 10.18632/oncotarget.18869. eCollection 2017 Sep 15.
Abnormality of thyroid hormones in liver diseases is common, but data is lacking in patients with type A hepatic encephalopathy (HE). The present study was aimed to determine whether there was an abnormality in thyroid hormones among patients with type A HE. We measured the levels of thyroid hormones in 36 acute liver failure (ALF) patients with type A HE and in 29 acute liver injury patients (international normalized ratio, INR ≥ 1.5) without encephalopathy as control. The clinical parameters associated with abnormality of thyroid hormones were evaluated. ALF patients with type A HE exhibited decreased TSH levels compared to patients without encephalopathy (0.17 1.08 μIU/mL, < 0.001). There was no difference in T3 and T4 levels (both total and free) between the two groups. The logistic regression analysis identified type A HE as an independent related factor for the occurrence of low TSH (Odds Ratio = 12.32) in patients with ALF. Correlation analysis showed that there was an inverse correlation between TSH level and the grade of encephalopathy (r = -0.795). Furthermore, patients with low TSH depicted poor survival rate than those with normal TSH level (29.3% 44.1%, = 0.003). Patients with type A HE exhibited subclinical central hypothyroidism, and had significant decreased TSH level, which had inverse correlation with the grade of encephalopathy. The reduced TSH was associated with poor survival rate.
肝脏疾病中甲状腺激素异常很常见，但甲型肝性脑病（HE）患者的数据尚缺。本研究旨在确定甲型HE患者中甲状腺激素是否存在异常。我们测量了36例甲型HE急性肝衰竭（ALF）患者以及29例无脑病的急性肝损伤患者（国际标准化比值，INR≥1.5）作为对照的甲状腺激素水平。评估了与甲状腺激素异常相关的临床参数。与无脑病患者相比，甲型HE的ALF患者促甲状腺激素（TSH）水平降低（0.17±1.08μIU/mL，P<0.001）。两组间三碘甲状腺原氨酸（T3）和甲状腺素（T4）水平（总水平和游离水平）无差异。逻辑回归分析确定甲型HE是ALF患者发生低TSH的独立相关因素（比值比=12.32）。相关性分析表明TSH水平与脑病分级呈负相关（r=-0.795）。此外，TSH低的患者生存率低于TSH水平正常的患者（29.3%对44.1%，P=0.003）。甲型HE患者表现为亚临床中枢性甲状腺功能减退，TSH水平显著降低，这与脑病分级呈负相关。TSH降低与生存率低有关。
