Studies On Changes Of Thyroid Hormone In Patients With Hepatic Failure

Objective:Through detect the serum thyroid hormone levels in hepatic failure,chronic severe hepatitis B and chronic mild to moderate hepatitis B hospitalized patients with (T3, T4, FT3, FT4) and thyroid stimulating hormone (TSH), to investigate whether thyroid hormone levels were associated with severity and prognosis of hepatic failure. To explore the causes of abnormal thyroid hormone in patients with hepatic failure. Through the detect the serum pituitary hormone levels hepatic failure, chronic severe hepatitis B and chronic mild to moderate hepatitis B hospitalized patients with thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and growth hormone (GH) and gonadotropin (LH, FSH) and prolactin(PRL), investigate in each group of patients with pituitary function change; To explore the pathogenesis of hypothalamic-pituitary-thyroid axis injury in patients with hepatic failure.Methods:We collected hospitalized patients with HF (HF group, n= 30) and chronic mild to moderate hepatitis B patients (chronic mild to moderate hepatitis B group, n= 58) and chronic severe hepatitis B patients, (chronic severe hepatitis B group, n= 35) in May 2015 to November 2015 in Nanjing Second Hospital Department of Hepatology, Detected and compared serum thyroid hormone levels and pituitary hormones (TSH, GH, FSH, LH, PRL, ACTH) levels in each group.Results:1 Comparison of the general data of patients with hepatic failure group,chronic mild to moderate hepatitis B group and chronic severe hepatitis B group of liver failure. The serum T3、FT3、TSH、FSH levels in hepatic failure group was significantly lower than that in chronic mild to moderate hepatitis B group (P< 0.05). The serum T3、T4 levels in hepatic failure group was significantly lower than that in chronic severe hepatitis B group (P< 0.05).The serum GH levels in hepatic failure group was significantly higher than that in chronic mild to moderate hepatitis B group (P< 0.05).2 Comparison of the general data of patients with hepatic failure death group and hepatic failure survival group. The serum TSH, FSH, LH levels in death group was significantly lower than that in the survival group (P<0.05).3 The correlation analysis between T3 and total bilirubin, albumin, prothrombin activity:T3 and total bilirubin, albumin, prothrombin activity were significantly related.4 Multinomial logistic regression analysis in hepatic failure,chronic severe hepatitis B and chronic mild to moderate hepatitis B hospitalized patients. Compared chronic severe hepatitis B group with chronic mild to moderate hepatitis B group, T3, DB and PT were significant differences,Compared hepatic failure group with chronic mild to moderate hepatitis B group, DB and PT were significant differences.5 Single factor Logistic regression analysis of risk factors for the prognosis of hepatic failure. Compared the death group and survival group,TSH and DB were significant differences.6 Multiple Logistic stepwise regression analysis of risk factors for the prognosis of hepatic failure.Obtained the regression equation of HF prognostic model was P= 1/ (1+e-y), y=2.009-1.838X13,P was the death probability of HF patients, X13 was represented the serum TSH.7 Draw ROC curve.The area under the ROC curve was 0.206,95% CI (0.008,0.404). The best critical value of TSH is 0.868, according to the formula P=1/(1+e-y), obtained the corresponding y value is 1.886.8 Predictive ability evaluation of regression model. The accuracy of model is 63.3%, the sensitivity of model is 30%,the specificity of model is 80%.9 Methods of using HF prognostic model, if Y≥1 1.886, the model predicts outcome is death, and Y value is greater, the possibility of death in patients with HF is higher; if Y<1.886, the model predicts outcome is survival, and the Y value is smaller, the possibility of survial in patients with HF is higher.Conclusion:1 The level of thyroid hormone in patients with hepatic failure is lower than that of patients with chronic hepatitis, T3, T4and FT3 are the main.2 Reduction of TSH is a risk factor for death in patients with hepatic failure, which be related to the prognosis of hepatic failure.3 The pituitary hormone levels in patients with hepatic failure were different than that in chronic hepatitis patients,mainly TSH, FSH, LH, ACTH decreased,reflecting the hypothalamic-pituitary-gonadal axis, the hypothalamic-pituitary adrenal-axis and the hypothalamic-pituitary-thyroid axis are abnormal, which is one of the reasons for the change of thyroid index.