Kano T, Kojima T, Takahashi T, Muto Y
Gastroenterol Jpn. 1987 Jun;22(3):344-53. doi: 10.1007/BF02774261.
To evaluate thyroid function in 19 patients with fulminant hepatitis (FH), we have measured total and free 3,5,3'-triiodothyronine (T3) and thyroxine (T4), 3,3',5'-triiodothyronine (reverse T3, rT3), thyroid-stimulating hormone (TSH) and thyroxin-binding globulin (TBG) in patients with FH, compared with those of 80 patients with other various liver diseases and of 10 healthy controls. Patients with FH showed the lowest values of serum T3 and the highest levels of rT3 among all patients with liver diseases studied. Furthermore, patients with FH showed a significant increase of rT3 in comparison with subacute hepatitis (SAH), "acute-on-chronic" (AOC) type of hepatic failure, ordinary and severe forms of acute hepatitis (AHo and AHs) and decompensated liver cirrhosis (LC-D). In addition, serum T3 and rT3 and the rT3/T3 ratio significantly correlated with prothrombin time (PT) and plasma methionine level. We also found that serum T3 and rT3 concentrations and the rT3/T3 ratio showed early and rapid normalization in cases of FH that survived, but they did not improve in patients with fatal outcome. These results suggest that serum T3, particularly rT3 concentrations and the rT3/T3 ratio may be useful indicators for assessing the severity and prognosis of patients with FH and can be considered to the sensitive indices for functioning hepatic microsomal reserve as well.
为评估19例暴发性肝炎（FH）患者的甲状腺功能，我们测定了FH患者的总三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）、甲状腺素（T4）、反三碘甲状腺原氨酸（rT3）、促甲状腺激素（TSH）和甲状腺素结合球蛋白（TBG），并与80例其他各种肝病患者及10名健康对照者进行了比较。在所有研究的肝病患者中，FH患者的血清T3值最低，rT3水平最高。此外，与亚急性肝炎（SAH）、“慢性加急性”（AOC）型肝衰竭、普通型和重型急性肝炎（AHo和AHs）以及失代偿期肝硬化（LC-D）相比，FH患者的rT3显著升高。此外，血清T3、rT3以及rT3/T3比值与凝血酶原时间（PT）和血浆蛋氨酸水平显著相关。我们还发现，存活的FH患者血清T3和rT3浓度以及rT3/T3比值早期迅速恢复正常，但死亡患者则无改善。这些结果表明，血清T3，尤其是rT3浓度以及rT3/T3比值可能是评估FH患者严重程度和预后的有用指标，也可被视为肝微粒体储备功能的敏感指标。
