Analysis Of Serum Thyroid Hormone Levels In Patients With Chronic Viral Hepatitis B And C

Objective:In order to investigate the relationship between the extent of the disease of chronic hepatitis B and C virus liver disease and thyroid hormone level and to provide clinical and theoretical basis for the diagnosis and prognosis of these patients,a retrospective analysis of the changes of serum thyroid hormone levels in patients with chronic type B and type C viral liver disease who ruled out primary thyroid disease are conducted.Methods:We enrolled 639 patients diagnosed with chronic viral liver disease,including135 patients with chronic hepatitis B,269 patients with Hepatitis B cirrhosis,97patients with chronic hepatitis C,138 patients with Hepatitis C cirrhosis,who had lived in the Department of hepatobiliary of The First Hospital of Jilin University.Firstly,according to the severity of disease,the patients with chronic hepatitis B and hepatitis C virus related chronic diseases were divided into different groups to compare the changes of thyroid hormone levels.Secondly,the patients with viral liver disease were divided into normal group and abnormal group according to the change of thyroid hormone.The difference of aspartate aminotransferase,alanine aminotransferase,albumin,Albumin/globulin ration,total bilirubin and coagulation function between the two groups was analyzed.In the end,the statistics were analyzed by the spss22.0 software.Results:1.The proportions of changes in serum TSH,FT₃,and FT₄ in patients with chronic hepatitis B virus respectively were 15.6%,23.0%,and 15.1%;and the rates of changes in the hepatitis C liver disease respectively were 19.6%,16.2%,and14.9%.The proportion of changes in TSH and FT₄ was not statistically different between the two groups,and the proportion of FT₃ changes was statistically different between the two groups.2.The levels of serum FT₃ and FT₄ in patients with hepatitis cirrhosis?types B and C?were significantly lower than those in chronic hepatitis?types B and C??P<0.001?;The levels of serum TSH in hepatitis cirrhosis group?types B and C?were lower than those in chronic hepatitis group?types B and C?,and the difference was not statistically significant?P=0.816?.3.We divided the patients with chronic hepatitis B into three groups of mild,moderate and severe,and then analyzed the variance of serum TSH,FT₃ and FT₄among the three groups.The levels of serum TSH and FT₄ were gradually increased in the three groups,with no statistically significant changes.The levels of serum FT₃ were the lowest in the severe group and the highest in the moderate group,with statistically significant changes?P<0.001?.We further compared the serum FT₃ with two groups.the level of FT₃ was significantly lower in the severe group than in the mild group and the moderate group?P=0.01,P<0.001?.The level of FT₃ in the moderate group was higher than that of mild group,and the difference was not statistically significant?P=0.074?.4.We divided the patients with chronic hepatitis C into three groups of mild,moderate and severe,and then analyzed the variance of serum TSH,FT₃ and FT₄among the three groups.The levels of serum TSH and FT₄ were gradually increased in the three groups,with no statistically significant changes;There was no significant change in FT₄ level among the three groups,and the change was not statistically significant.The levels of serum FT₃ were the lowest in the severe group and the highest in the moderate group,with statistically significant changes?P<0.001?.We further compared the serum FT₃ with two groups.The serum FT₃ level in the severe group was significantly lower than that in the moderate group?P=0.031?.The FT₃level in the severe group was lower than that in the mild group,and the FT₃ level in the moderate group was lower than that in the mild group.The difference was not statistically significan.5.We performed Child-Pugh grading?A,B,C?for patients with cirrhosis after HBV and HCV,and then analyzed the variance of serum TSH,FT₃ and FT₄ among the three groups.The levels of serum FT₃ showed a significant downward trend between the three groups,the difference was statistically significant?P<0.001?,The levels of TSH,FT₄ showed no significant difference among the three groups,and the difference was not statistically significan.We further compared the serum FT₃ with two groups.The level of FT₃ in group B was significantly lower than that of group A.The level of FT₃ in group C was significantly lower than that of group A and B,with statistical significance?P<0.001?.6.Among the patients with chronic hepatitis C,the proportions of the 3a,1b,and unclassified genotypes in the normal thyroid hormone group were 47.6%,42.9%,and9.5%,respectively;the percentages in the abnormal group were 47.7%,44.3%,and8.0%,respectively.There was no statistically significant difference among the groups?P=0.914?.7.The proportion of abnormal TPO-Ab and Tg-Ab in patients with chronic HCV-type liver disease was 29.0%and 18.6%were significantly higher than those in patients with chronic-type B viral hepatitis?14.9%,4.5%?,and the differences were statistically significant.Significance?P<0.001,P=0.005?.8.In patients with chronic hepatitis B and C viral diseases,the liver function indexes of the normal and abnormal thyroid hormone levels were compared.The levels of AST,ALT,and TBIL in the serum TSH abnormal group were higher than those in the normal group,and the PT was longer than normal.The levels of PTA,ALB,and A/G in the serum TSH abnormal group were lower than the normal group,but the difference was not statistically significant;the levels of AST,ALT,and TBIL in the serum FT₃ abnormal group were higher than those in the normal group,and the prolongation of PT was more obvious than that of the normal group,and the levels of ALB,PTA was lower than the normal group,the difference was statistically significant.The serum FT3 abnormal group had lower A/G than the normal group,but the difference was not statistically significant.Conclusion:1.The serum levels of FT₃ and FT₄ in patients with cirrhosis are lower than those with chronic hepatitis in patients with chronic hepatitis B and C viral disease.2.The serum levesl of FT₃ did not decrease gradually with mild,moderate,or severe disease in patients with chronic hepatitis,but The serum levels of FT₃decreased significantly in patients with severe hepatitis.3.The serum levels of FT₃ showed a gradual decline with Child-Pugh A,B,and C grades in cirrhotic patients.4.The changes of serum thyroid hormone levels in patients with chronic viral hepatitis C have no significant relationship with genotyping.5.Patients with chronic hepatitis C are more likely to have abnormal TPOAb and Tg-Ab antibodies than patients with hepatitis B.