肝衰竭患者甲状腺激素变化水平的研究

发布时间：2017-12-26 19:32

本文关键词：肝衰竭患者甲状腺激素变化水平的研究　出处：《东南大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过检测肝衰竭、病毒性肝炎乙型慢性重度、病毒性肝炎乙型慢性轻中度住院患者甲状腺激素(T3、T4、FT3、FT4)及TSH水平的动态变化,探讨甲状腺激素水平与肝衰竭严重程度和预后的相关性。探索甲状腺激素在肝衰竭患者中出现异常的原因。检测肝衰竭患者、病毒性肝炎乙型慢性重度、病毒性肝炎乙型慢性轻中度住院患者的垂体分泌激素促甲状腺激素(TSH)、促肾上腺激素(ACTH)、促性腺激素(LH, FSH)及生长激素(GH)、催乳素(PRL)的水平,研究各组患者的垂体功能改变；探索肝衰竭患者是否存在下丘脑-垂体-甲状腺轴损伤的发病机制。方法：于2015年5月至2015年11月收集在南京市第二医院肝病科住院的肝衰竭患者(肝衰竭组,n=30),慢性乙型肝炎轻中度患者(慢性乙型肝炎轻中度组,n=58)和慢性乙型肝炎重度患者(慢性乙型肝炎重度组,n=35)。检测并比较各组的血清甲状腺激素水平以及垂体激素(TSH, GH, FSH, LH, PRL, ACTH)水平。结果：1肝衰竭组与慢性乙型肝炎轻中度组、慢性乙型肝炎重度组研究对象一般资料的比较肝衰竭组血清T3、FT3、TSH、FSH水平显著低于慢性乙型肝炎轻中度组T3、 FT3、TSH、FSH水平(P0.05),肝衰竭组血清T3、T4水平显著低于慢性乙型肝炎重度组T3、T4水平(P0.05),肝衰竭组血清GH水平显著高于慢性乙型肝炎轻中度组GH水平(P0.05)。2肝衰竭死亡组和生存组一般情况比较肝衰竭死亡组TSH、FSH、LH明显低于生存组TSH、FSH、LH水平(P0.05)。3 T3与总胆红素、白蛋白、凝血酶原活动度相关性分析：T3与总胆红素、白蛋白、凝血酶原活动度显著性相关。4肝炎轻中度、重度、肝衰竭的多分类Logistic回归分析慢性乙型肝炎重度组较轻中度组相比T3、DB、PT差异有统计学意义,肝衰竭组较慢性乙肝轻中度组相比DB、PT差异有统计学意义。5肝衰竭预后危险因素的单因素Logistic回归分析死亡组较生存组TSH、DB差异有统计学意义。6肝衰竭预后危险因素的多因素Logistic逐步回归分析得到HF预后模型的回归方程为：P=1、(1+e-y),y=2.009-1.838X13其中P为HF患者的死亡概率,X13代表血清TSH。7绘制ROC曲线ROC曲线下的面积为0.206,95%的可信区间为(0.008,0.404)。TSH的最佳临界值为0.868,根据公式P=1/(1+e-y)得到对应的y值为1.886。8回归模型预测能力评价该模型的预测准确率为63.3%,预测模型敏感性为30%,特异性为80%。9 HF预后模型的使用方法若Y≥1.886,则该模型预测结果为死亡,且Y值越大,HF患者死亡的可能性越大；若Y1.886,预测为生存,而且Y值越小,生存的可能性越大。结论：1肝衰竭患者甲状腺激素水平较慢性肝炎患者降低,以T3、T4、FT3为主。2 TSH降低是肝衰竭患者死亡的危险因素,和预后相关。3肝衰竭患者垂体功能异常,主要表现为TSH、FSH、LH、ACTH的下降,反映下丘脑-垂体-性腺轴、下丘脑-垂体-肾上腺轴和下丘脑-垂体-甲状腺轴均存在异常,该异常可能是甲状腺指标变化的原因之一。
[Abstract]:Objective: to detect the liver failure, hepatitis B, chronic severe hepatitis B patients with mild to moderate chronic thyroid hormone (T3, T4, FT3, FT4) and the dynamic changes of TSH level, the correlation of thyroid hormone level and the severity and prognosis of liver failure. To explore the abnormal causes of thyroid hormone in patients with liver failure. Detection of patients with liver failure, hepatitis B, chronic severe hepatitis B with mild to moderate chronic hospitalized patients with pituitary hormone secretion of thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), gonadotropin (LH, FSH) and growth hormone (GH), prolactin (PRL) level change in study group patients with pituitary function in patients with liver failure; to explore whether there is injury of hypothalamic pituitary thyroid axis. Methods: from May 2015 to November 2015 were collected in patients with liver failure Second Hospital of Nanjing City Hospital (liver failure group, n=30), mild chronic hepatitis B patients (mild chronic hepatitis B group, n=58) and severe chronic hepatitis B patients (chronic hepatitis B group, n=35). The levels of serum thyroid hormones and the levels of pituitary hormone (TSH, GH, FSH, LH, PRL, ACTH) were measured and compared. Results: 1 liver failure group and chronic hepatitis group, mild to moderate general data of severe chronic hepatitis B group study the serum T3, liver failure group FT3, TSH and FSH levels were significantly lower than those of mild chronic hepatitis B group T3, FT3, TSH, FSH (P0.05), the level of serum T3 and T4 levels in liver failure the level of T4 group was significantly lower than that of severe chronic hepatitis B group, T3 (P0.05), serum GH level in liver failure group was significantly higher than that of chronic hepatitis B GH moderate group (P0.05). 2 the general cases of liver failure death group and survival group compared with the death group of liver failure, TSH, FSH, LH were significantly lower than the survival group TSH, FSH, LH level (P0.05). The correlation of 3 T3 with total bilirubin, albumin and prothrombin activity: T3 was significantly associated with total bilirubin, albumin and prothrombin activity. 4 Logistic regression analysis of hepatitis B, mild, moderate, severe and liver failure showed a statistically significant difference in T3, DB and PT compared with mild and moderate chronic hepatitis B severe group. There was significant difference between DB and PT in liver failure group compared with chronic hepatitis B mild to moderate group. 5 the single factor Logistic regression analysis of the risk factors for the prognosis of liver failure was statistically significant in the difference of TSH and DB in the death group compared with the survival group. 6 multivariate Logistic stepwise regression analysis of the prognosis risk factors of liver failure showed that the regression equation of HF prognosis model was P=1 and 1+e-y, y=2.009-1.838X13, P was the death probability of HF patients, X13 represented serum TSH. 7 the confidence interval of the area of 0.206,95% under the ROC curve of the ROC curve is (0.008,0.404). The optimal critical value of TSH is 0.868, and the corresponding y value is 1.886 according to the formula P=1/ (1+e-y). The prediction accuracy of the 8 regression model is 63.3%, the sensitivity of the prediction model is 30%, and the specificity is 80%. Using the method of 9 HF prognostic model if Y is greater than 1.886, the prediction results of death, and the Y value is greater, the greater possibility of death in patients with HF; if Y1.886, the prediction of survival, and the Y value is smaller, the greater the likelihood of survival. Conclusion: the level of thyroid hormone in 1 patients with liver failure is lower than that of chronic hepatitis, with T3, T4 and FT3 as the main factors. 2 TSH reduction is a risk factor for death in patients with liver failure and is associated with the prognosis. 3 pituitary dysfunction in patients with liver failure, mainly for the decline of TSH, FSH, LH, ACTH, reflect the hypothalamic pituitary gonadal axis and hypothalamic pituitary adrenal axis and hypothalamus pituitary thyroid axis were abnormal, the abnormal thyroid index may be one of the reasons for change.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R575.3

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