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目的:肝脏是甲状腺激素降解、排泄及转化的场所,参与甲状腺结合球蛋白的合成。肝脏及肝脏疾病与甲状腺激素关系方面的文献很多,但有关婴儿肝炎综合征(infantile hepatitis syndrome,IHS)甲状腺素水平的报道很少。本文研究IHS患儿血清甲状腺素水平与Child-Pugh肝功能分级的关系,探讨甲状腺素水平对于指导肝功能的分级、评价肝脏储备功能及其预后的临床意义。方法:收集住院的IHS患儿38例,选择20例健康儿作为正常对照组。应用放射免疫法检测各组血清促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平。检测IHS患儿血清白蛋白(ALB)、总胆红素(TBIL)、凝血酶原时间(PT),并记录腹水、肝性脑病等临床情况,按成人Child-Pugh分级标准,将患儿分为A、B、C三级,并将Child-Pugh积分与其甲状腺功能各指标做相关性分析。结果:1、IHS组患儿血清FT3、FT4水平显著低于正常对照组(P<0.05),TSH水平高于正常对照组水平(P<0.05);FT3、FT4水平随Child-Pugh积分增加而下降,A、B、C三级组间比较有显著性差异(P<0.05);TSH水平在三级组间无统计学差异(P>0.05)。2、HIS患儿的血清FT3、FT4水平与Child-Pugh积分呈负相关(r=-0.619～-0.80,P<0.01),与TSH无相关性(P>0.05)。结论:本研究结果显示婴儿肝炎综合征患儿的血清FT3、FT4水平降低,且与其肝脏受损程度有明显的相关性,因此检测血清FT3、FT4水平,对正确评估婴儿肝炎综合征病情严重程度及其预后具有重要的参考价值。
Purpose: The liver is a site of thyroid hormone degradation, excretion and conversion and is involved in the synthesis of thyroid binding globulin. There is a lot of literature about the relationship between liver and liver diseases and thyroid hormones, but little is known about the level of thyroxine in infantile hepatitis syndrome (IHS). This study was to investigate the relationship between serum thyroxine level and Child-Pugh liver function classification in children with IHS and to explore the clinical significance of thyroxine level in guiding liver function classification and evaluating liver reserve function and prognosis. Methods: 38 cases of IHS children were collected and 20 healthy children were selected as normal control group. Serum thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were measured by radioimmunoassay. Serum albumin (ALB), total bilirubin (TBIL) and prothrombin time (PT) were detected in IHS children. Clinical records of ascites and hepatic encephalopathy were recorded. According to the Child-Pugh classification criteria, A, B, C three levels, and Child-Pugh integral and thyroid function of each index correlation analysis. The levels of serum FT3 and FT4 in IHS group were significantly lower than those in normal control group (P <0.05), TSH level was higher than that in normal control group (P <0.05); FT3 and FT4 levels increased with Child-Pugh integral (P <0.05). There was no significant difference in the level of TSH between the three groups (P> 0.05). The levels of FT3 and FT4 in children with HIS were negatively correlated with Child-Pugh score (r = -0.619-0.80, P <0.01), but not with TSH (P> 0.05). Conclusion: The results of this study showed that serum FT3 and FT4 levels in infants with hepatitis syndrome decreased and their liver damage was significantly correlated with each other. Therefore, serum levels of FT3 and FT4 were measured and the severity of infant hepatitis syndrome was correctly evaluated And its prognosis has important reference value.