| Object:There are distinct clinic manifestation and pathogenesis between hepatic encephalopathy (HE) due to acute liver failure (ALF) and due to cirrhosis. Whether both type hepatic encephalopathy affect thyroid hormones levels remain unknown. This essay aims to observe the changes and significance of thyroid hormone among different HE patients, thus to provide the further reference evidence for clinical judgment of liver reserve function, synergistic pathogenesis between thyroid hormone and related clinical parameters.Methods:1.We choose107patients hospitalized in Tianjin Second People’s Hospital including,57patients with HE secondary to ALF;50cirrhotic patients:24patients with HE and26patients without it; We collect the blood sample, test the related indicators of liver and kidney function、INR、PT and thyroid hormone, to study the changes and significance of thyroid hormone among different HE patients.2.1n order to find the different changes among different types of HE, we should compare the date between two two groups using t test, according to the properties of various data.3.Analysis the correlation between TSH, FT4, INR, MELD, NH3and acute hepatic failure caused by HE.4.Analysis the correlation between TSH, FT3, MELD, NH3and HE caused by liver cirrhosis.Results:1.In patients with HE caused by liver cirrhosis and no HE, the ALT, AST, Cr, PT, TSH、FT4and TT4has no difference(P>0.05), but there is difference in TBIL, NH3, INR and MELD (P<0.01or P<0.05). TT3, FT3has down trend, the difference had statistical significance (P<0.05).2. Compared with ALF group and no encephalopathy group, after attacked by HE, the thyroidal hormones (TSH、TT4、TT3、FT3) in patients are downtrend (P<0.01or P<0.05); FT4increased after the onset (P<0.05), and the liver function also shows deterioration trend:TBIL higher, PT longer, INR larger, MELD bigger (P<0.01or P<0.05); however, ALT、AST、Cr and NH3has no statistical difference before or after HE (P>0.05).3.Compared with patients of HE due to cirrhosis, the HE patients caused by ALF shows more severe liver dysfunction:higher level of ALT, AST, TBIL, INR, PT, Cr and more MLED (P<0.01or P<0.05), however, lower level of NH3(P<0.05).TT3and FT3has no statistical difference in those two groups(P>0.05).4. In encephalopathy caused by ALF group, there is negative correlation between TSH density and HE lesion level(r=-0.678, P<0.01); on other hand, there is positive correlation between INR, MELD and HE level(r=0.460, P=0.008; r=0.503, P=0.003).But no correlation between NH3, FT4and encephalopathy (r=0.289,P=0.108; r=0.155,P=0.397)5.Cirrhosis of the liver caused by encephalopathy, there is negative correlation between FT3density and HE lesion level(r=-0.335, P=0.043); there is significant correlation in INR, MELD, NH3and HE level (r=0.369, P=0.028;r=0.416, P=0.013; r=0.589, P=0.000); and no correlation in TSH density and HE (r=-0.278, P=0.078)Conclusion:1.Among the patients with HE caused by liver cirrhosis, T3and FT3shows the illness severity, and FT3has the negative correlation with it. It may be has correlation with the following issue:The decrease of liver cells number and synthesis function of HE caused by liver cirrhosis has minus concern with hypothalamic-pituitary-thyroid axis.2.Among the HE patients caused by ALF, when the HE occurred, TSH、T3and T4are decreased, central thyroid function lowed, TSH decreased sharply and has negative correlation with HE severity. It may be concerned with the following reason:When HE caused by ALF occurred, cerebral edema and intracranial pressure cause the hypothalamus and pituitary dysfunction is more severe, causing TSH secretion.3.Different HE has different influence on hypothalamic-pituitary-thyroid axis, different thyroid hormone in different HE maybe have correlation with it, and thyroid hormone together with related clinical parameters take part in disease developing. |
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