丙型肝炎与甲状腺功能异常相关性的临床研究

Clinical study on the correlation between hepatitis C and thyroid dysfunction

摘要:

目的 探讨慢性丙型肝炎（chronic hepatitis C，CHC）和甲状腺功能异常（thyroid dysfunction，TD）的相关性以及慢性丙型肝炎患者中TD的预测因素。方法 选取2018年6月至2021年12月在云南省第一人民医院确诊为CHC的患者95例，根据其血清丙型肝炎病毒（hepatitis C virus，HCV）-RNA表达水平，分为低HCV-RNA组（<10⁵ IU/mL）（37例）和高HCV-RNA组（>10⁵ IU/mL）（47例），随机选取同期至本院体检的健康者41例；收集相关实验室指标，包括促甲状腺激素（thyroid stimulating hormone，TSH）、甲状腺素（thyroxine，T4）、三碘甲状腺原氨酸（triiodothyronine，T3）、游离甲状腺素（free thyroxine，FT4）、游离三碘甲状腺原氨酸（free triiodothyronine，FT3）、谷草转氨酶（aspartate transaminase，AST）、谷丙转氨酶（alanine aminotransferase，ALT）、碱性磷酸酶（alkaline phosphatase，ALP）、总胆红素（total bilirubin，TBIL）、直接胆红素（direct bilirubin，DBIL）、总蛋白（total protein，TP）、白蛋白（albumin，ALB）、球蛋白（globulin，GLB）、尿素氮（blood urea nitrogen，BUN）、肌酐（creatinine，Cr）、血糖（glucose，G），来探讨CHC患者的甲状腺激素及相关生化指标与HCV-RNA载量的关系。根据其是否合并TD分为单纯丙肝组和丙肝合并TD组，选取丙肝合并TD组14例，单纯丙肝组15例，随机选取同期健康体检者15例作为对照组，对3组病例的实验室指标进行统计学分析。结果 95例慢性丙型肝炎患者中，合并TD者共15例，检出率为15.79%。对照组、低HCV-RNA组、高HCV-RNA组3组相比，T4、T3、FT4、FT3、AST、ALT、DBIL、ALB、GLB差异具有统计学意义（P<0.05），对有意义的指标进行无序多元logistic回归分析显示，低表达组与对照组相比，GLB（OR=1.379，95%CI=1.060~1.5793，P<0.05）可能是病毒载量升高的预测因素；高表达组与对照组相比，GLB（OR=1.425，95%CI=1.094~1.856，P<0.05）可能是预测因素；高表达组与低表达组相比，FT3（OR=3.543，95%CI=1.472~8.356，P<0.05）可能是预测因素。对照组、单纯丙肝组、丙肝合并甲状腺功能障碍组3组相比，TSH、FT4、FT3、AST、ALT、ALP、ALB、GLB差异具有统计学意义（P<0.05）。结论 慢性丙型肝炎患者的病毒载量水平与甲状腺激素水平有关，对临床有一定指导意义。

Abstract:

Objective To explore the correlation between chronic hepatitis C（CHC） and thyroid dysfunction（TD），and the predictors of TD induced by hepatitis C.Methods A total of 95 patients diagnosed with CHC in The First People's Hospital of Yunnan Province from June 2018 to December 2021 were selected， and they were divided into low hepatitis C virus（HCV）-RNA group（<10⁵ IU/mL） （37 cases） and high HCV-RNA group（>10⁵ IU/mL）（47 cases），according to their HCV-RNA expression level. And 41 healthy controls were selected randomly from whom made the physical examination in our hospital at the same period. Relevant laboratory indicators， including thyroid stimulating hormone（TSH），thyroxine（T4），triiodothyronine（T3），free thyroxine（FT4），free triiodothyronine （FT3），aspartate transaminase（AST），alanine aminotransferase（ALT），alkaline phosphatase（ALP），total bilirubin（TBIL），direct bilirubin（DBIL），total protein（TP），albumin（ALB），globulin（GLB），blood urea nitrogen（BUN），creatinine（Cr），and glucose（G），were collected to explore the relationship between thyroid hormone and related biochemical indicators and HCV-RNA load in CHC patients. According to whether they had TD or not， they were divided into hepatitis C group and hepatitis C combined with TD group. Fourteen cases of hepatitis C combined with TD group and 15 cases of hepatitis C group were selected，and 15 cases of healthy people were randomly selected as the control group. The laboratory indicators of the three groups were statistically analyzed.Results Among 95 patients with CHC，15 patients were complicated with TD，and the detection rate was 15.79%. Compared with the control group，the low HCV-RNA group and the high HCV-RNA group were significantly different in T4，T3，FT4，FT3，AST，ALT，DBIL，ALB and GLB（P<0.05）. Disordered multiple logistic regression analysis showed that GLB（OR=1.379，95%CI=1.060-1.5793，P<0.05） might be a predictor of increased viral load. Compared with the control group，GLB（OR=1.425，95%CI=1.094-1.856，P<0.05） could be a predictor， FT3 （OR=3.543， 95%CI=1.472-8.356，P<0.05） could be a predictor. There were significant differences in TSH，FT4，FT3，AST，ALT，ALP，ALB and GLB among the control group， hepatitis C group and hepatitis C combined with TD group（P<0.05）.Conclusion The level of viral load in patients with CHC is related to the level of thyroid hormone， which has certain guiding significance for clinical practice.