Caregaro L, Alberino F, Amodio P, Merkel C, Angeli P, Plebani M, Gatta A
Dipartimento di Medicina Clinica e Sperimentale, University of Padua, Italy.
J Hepatol. 1998 Jan;28(1):115-21. doi: 10.1016/s0168-8278(98)80210-9.
BACKGROUND/AIMS: A variety of severe illnesses can induce changes in thyroid hormone metabolism, leading to findings referred to as "sick euthyroid syndrome". In several groups of patients the reduction of serum thyroxine concentration (T4), characteristic of the low-T4 variant of sick euthyroid syndrome, has been found to be a good predictor of survival. Although the pathophysiology of hormonal alterations has not yet been defined, nutritional deficits have been suggested to play a role. The study aimed to define the prognostic and nutritional significance of serum thyroxine in liver cirrhosis.
Thyroid hormones and nutritional status were evaluated in a group of 75 consecutive hospitalized patients with cirrhosis, followed-up clinically for 12 months.
A low-T4 variant of sick euthyroid syndrome was found in 23 of the 75 enrolled patients with cirrhosis (30.6%). Serum T4, but not serum T3, correlated with mid-arm muscle circumference (p < 0.01), an indicator of muscle protein compartment. While both serum T3 and T4 correlated directly with serum proteins and inversely with Child-Pugh score, only T4 was predictive of outcome. Patients with the low-T4 variant of sick euthyroid syndrome showed significantly lower short- and long-term survival rates compared to those with normal serum T4 concentrations (p < 0.008 at 3 months, p < 0.001 at 6 months and 1 year). A multivariate analysis using the proportional hazards Cox's regression procedure showed that serum T4, but not serum T3 or nutritional parameters, improves the prognostic capacity of Child-Pugh score (p < 0.01).
These data indicate that the low T4-variant of sick euthyroid syndrome distinguishes a subgroup of patients with cirrhosis at risk for decreased survival. The inclusion of T4 in the Child-Pugh score, by improving its prognostic power, may optimize the selection of patients with advanced cirrhosis to receive specific therapy such as transplantation.
背景/目的：多种严重疾病可引起甲状腺激素代谢改变，导致所谓“病态正常甲状腺综合征”的表现。在几组患者中，血清甲状腺素浓度（T4）降低是病态正常甲状腺综合征低T4变异型的特征，已被发现是生存的良好预测指标。尽管激素改变的病理生理学尚未明确，但营养缺乏被认为起了一定作用。本研究旨在确定血清甲状腺素在肝硬化中的预后和营养意义。
对连续收治的75例肝硬化住院患者进行甲状腺激素和营养状况评估，并进行为期12个月的临床随访。
75例纳入研究的肝硬化患者中有23例（30.6%）出现病态正常甲状腺综合征的低T4变异型。血清T4而非血清T3与上臂中部肌肉周长相关（p<0.01），上臂中部肌肉周长是肌肉蛋白成分的一个指标。虽然血清T3和T4均与血清蛋白直接相关，与Child-Pugh评分呈负相关，但只有T4可预测预后。与血清T4浓度正常的患者相比，病态正常甲状腺综合征低T4变异型患者的短期和长期生存率显著降低（3个月时p<0.008，6个月和1年时p<0.001）。使用比例风险Cox回归程序进行的多变量分析显示，血清T4而非血清T3或营养参数可提高Child-Pugh评分的预后能力（p<0.01）。
这些数据表明，病态正常甲状腺综合征的低T4变异型可区分出一组生存风险降低的肝硬化患者。将T4纳入Child-Pugh评分，通过提高其预后能力，可优化晚期肝硬化患者接受移植等特定治疗的选择。
