甲狀腺激素濃度在不同程度肝硬化病人之變化

Changes of Serum Thyroid Hormone Levels in Patients with Liver Cirrhosis

楊東和(Ton-Ho Young) ； 黃文盛(Wen-Sheng Huang) ； 趙有誠(Yu-Cheng Chao) ； 許重得(Chung-Te Hsu) ； 陳維廉(Wei-Lian Chen) ； 郭熙文(S. W. Kuo) ； 吳興鏞(Sing-Yung Wu) ； 唐鴻舜(Hung-Shang Tang)

《Journal of Medical Sciences》 15卷3期 (1994/12) Pp. 171-180

摘要

Liver is a major peripheral organ of the thyroid hormone metabolism, and cirrhosis is a liver disease commonly discovered among the people. In order to understand changes of thyroid hormones in cirrhosis to various extents, this study is conducted and based on the discovery by the Hepatobiliary Research Center of Tri-service General Hospital that collected the serum from 45 cases of cirrhotic patients and classified them into three groups, i.e. Class A, B & C, in line with the serious extents of their cirrhosis according the Modified Child's classification, each group comprises 15 cases and another 15 cases of normal healthy persons in the same age range are observed as the control group. The thyroid functions in general of all their serums are tested by the method of immunoradio logical assay, including such tests as T4, T3, FT4, T8H, TBG and γT3, and the self-developed immunoradiologic assasy and determination of both thyroxine-sulfate (T4S) and triiodothyronine sulfate (T3S) are used to observe the conventional and substitutive metabolic changes of thyroid hormones of the cirrhotic patients with different severities. The initial results indicate that the metabolic changes of all these three-group patients suffering cirrhotic increase along with their sverities, and the T4, T3, and TBG of their serum significantly decreased, wherein the patients' T3 Value of groups B and C is lower than the normal value, the FT4 value of group A is rather high (to wit, group A in comparison with group B or C, p ＜ 0.05) , and γT3 value of group B and C significantly increased (to wit, group A in comparison with group B or C, p ＜ 0.05) but there is no obvious difference between groups B and C, and γT3/T3 ratio indicates that all these three groups have significantly progressive changes. 8ince there is no obvious change of T8H value among these three groups in the aspect of sulfated thyroid hormones, We can tell that the T38 values of the control group and all the three groups A, B and C increased significantly (The serum concentration of the control group and the three groups A, B and C is 2.76±0.37 ng/dl, 4.60±0.60 ng/dl, 6.30±0.65 ng/dl and 14.84±2.23 ng/dl respect tively, p ＜ 0.05 among various groups). T4S value changes insignificantly and less than 2 ng/dl expect that of group C which is slightly higher (4.21±0.05 ng/dl). Our initial conclusion is so: (1) The different severities of cirrhotic patients will lead to the changes of thyroid hormones concentration of their serum which include the dropping T4 and T3 and the rising γT3, the former is possibly related to the lower TBG value, and the latter is related to the abnormal liver function always leading to the resistance against the T3 synthesis and the γT3 metabolism; (2) The increasing T3S value of serum may further indicate that the type I deiodinative enzyme in the liver of cirrhotic patients may be lowered.

關鍵字

甲狀腺激素 ； 硫酸化甲狀腺激素 ； 肝硬化

並列摘要

Liver is a major peripheral organ of the thyroid hormone metabolism, and cirrhosis is a liver disease commonly discovered among the people. In order to understand changes of thyroid hormones in cirrhosis to various extents, this study is conducted and based on the discovery by the Hepatobiliary Research Center of Tri-service General Hospital that collected the serum from 45 cases of cirrhotic patients and classified them into three groups, i.e. Class A, B & C, in line with the serious extents of their cirrhosis according the Modified Child's classification, each group comprises 15 cases and another 15 cases of normal healthy persons in the same age range are observed as the control group. The thyroid functions in general of all their serums are tested by the method of immunoradio logical assay, including such tests as T4, T3, FT4, T8H, TBG and γT3, and the self-developed immunoradiologic assasy and determination of both thyroxine-sulfate (T4S) and triiodothyronine sulfate (T3S) are used to observe the conventional and substitutive metabolic changes of thyroid hormones of the cirrhotic patients with different severities. The initial results indicate that the metabolic changes of all these three-group patients suffering cirrhotic increase along with their sverities, and the T4, T3, and TBG of their serum significantly decreased, wherein the patients' T3 Value of groups B and C is lower than the normal value, the FT4 value of group A is rather high (to wit, group A in comparison with group B or C, p ＜ 0.05) , and γT3 value of group B and C significantly increased (to wit, group A in comparison with group B or C, p ＜ 0.05) but there is no obvious difference between groups B and C, and γT3/T3 ratio indicates that all these three groups have significantly progressive changes. 8ince there is no obvious change of T8H value among these three groups in the aspect of sulfated thyroid hormones, We can tell that the T38 values of the control group and all the three groups A, B and C increased significantly (The serum concentration of the control group and the three groups A, B and C is 2.76±0.37 ng/dl, 4.60±0.60 ng/dl, 6.30±0.65 ng/dl and 14.84±2.23 ng/dl respect tively, p ＜ 0.05 among various groups). T4S value changes insignificantly and less than 2 ng/dl expect that of group C which is slightly higher (4.21±0.05 ng/dl). Our initial conclusion is so: (1) The different severities of cirrhotic patients will lead to the changes of thyroid hormones concentration of their serum which include the dropping T4 and T3 and the rising γT3, the former is possibly related to the lower TBG value, and the latter is related to the abnormal liver function always leading to the resistance against the T3 synthesis and the γT3 metabolism; (2) The increasing T3S value of serum may further indicate that the type I deiodinative enzyme in the liver of cirrhotic patients may be lowered.

並列關鍵字

Thyroid hormones ； sulfated thyroid hormones ； liver cirrhosis