Correlations Between Thyroid Hormone Levels And Disease Severity In Patients With Hepatitis B Cirrhosis

BackgroundsCirrhosis is the end stage of many liver diseases.Hepatitis B virus infection is still one of the most common causes of cirrhosis in China.The main pathological feature of chronic hepatitis B cirrhosis is that nodular regeneration of hepatocytes forms pseudolobules on the basis of diffuse liver fibrosis.Patients often suffer from gastrointestinal bleeding,hepatic encephalopathy,hepatorenal syndrome during decompensated period of hepatitis B cirrhosis.The condition is easy to relapse and the treatment is difficult.Assessing the severity of a patient's condition accurately and formulating appropriate therapeutic regimens timely can greatly improve the quality of life and the prognosis of patients.The commonly used methods for assessing liver function in patients with liver cirrhosis are Child-Pugh score and MELD score.Both methods have their own advantages and limitations.People without previous history of thyroid disease may appear abnormal thyroid function during the course of acute or chronic diseases,which was called "euthyroid sick syndrome".The most common changes in thyroid hormone levels include decreased free triiodothyroxine(FT3),normal or decreased thyroid stimulating hormone(TSH)and elevated reverse triiodothyronine(rT3).Studies found that,decreased FT3 are associated with an increased risk of mortality among intensive care unit patients,heart disease patients,congestive heart failure patients,and hemodialysis patients.As the body's largest metabolic organ,the liver not only can regulate the process of body's metabolism,detoxification,immunity and biological transformation,but also can regulate the synthetic and metabolic process of insulin-like growth factors,multiple hormone-binding proteins,and transporter proteins.Therefore,liver disease may influence the function of the endocrine system.As the body's largest endocrine gland,the thyroid can regulate the body's growth,development and basal metabolism in many ways.It is also very important to maintain normal liver function and bilirubin metabolism.The liver plays an important role in thyroid hormone metabolism,and liver disease may cause changes in thyroid hormone levels.In addition to liver function and coagulation function abnormalities,thyroid function abnormalities may also occur during the clinical diagnosis and treatment in patients with hepatitis B cirrhosis,and the thyroid hormone levels of patients may be closely related to liver function.At present,there are some related studies on thyroid function in patients with liver diseases at home and abroad.However,most of the studies did not distinguish the etiology of cirrhosis,and the results were also different.There are few studies on thyroid function of cirrhosis caused by hepatitis B virus.ObjectiveTo analyze the changes of thyroid hormone levels in hepatitis B cirrhosis patients and its correlation with the severity of cirrhosis,and to explore the significance of thyroid hormones in the clinical assessment of the severity of liver cirrhosis.MethodsWe retrospectively analyzed the data of 180 patients who were diagnosed with hepatitis B cirrhosis from January 1,2018 to January 1,2019,in the department of gastroenterology,the first affiliated hospital of Zhengzhou University.We collected the general clinical profiles such as age and gender after admission,and collected the fasting blood sample in the next morning to measure indicators such as blood routine,liver function,renal function,coagulation function,and thyroid function(FT3,FT4,TSH)etc.We evaluated the conditions of hepatic encephalopathy according to the staging standard,and estimated the degrees of ascites through abdominal ultrasound.Then we calculated the Child-Pugh score and grades of patients,and model for end stage liver disease(MELD)score.During the same period,180 healthy subjects who visited the outpatient clinic of our hospital were selected as the control group,and their age,gender data,liver function and thyroid function data were collected.We counted the thyroid dysfunction conditions and the incidence of patients with hepatitis B cirrhosis.And we used t-test method to compare the liver function and thyroid function between the hepatitis B cirrhosis group and the control group,and compared the differences in thyroid hormone levels between patients with or without ascites groups,with or without hepatic encephalopathy groups.One-way analysis of variance method was used to compare the differences between different Child-Pugh grades and different MELD groups.Spearman rank correlation coefficient method was used to analyze the correlation between thyroid hormones and different biochemical indexes,Child-Pugh score,and MELD score in patients with hepatitis B cirrhosis.P value<0.05 means the difference is statistically significant.Results?A total of 48(26.67%)of the 180 patients with hepatitis B cirrhosis developed thyroid dysfunction,which were mainly manifested as low FT3(18.33%),low TSH(6.11%),high TSH(2.78%),low FT4(2.22%)and high FT4(2.22%).In terms of the incidence,low FT3 and low TSH are more common.?To compared with the control group,hepatitis B cirrhosis group had higher ALT,AST,GGT,ALP,TBIL and FT4 levels,and lower ALB and FT3 levels(p<0.05);while the TSH level was comparative(p>0.05).?Compared with the non-ascites group,the ascites group had decreased FT3,TSH and increased FT4 in patients with hepatitis B cirrhosis.The differences were statistically significant(p<0.05).?Compared with the non-hepatic encephalopathy group,FT3,FT4 and TSH levels in the hepatic encephalopathy group did not have statistically differences in patients with hepatitis B cirrhosis(p<0.05).?The levels of FT3,FT4,and TSH were different between the groups of Child-Pugh A,B,and C grades in patients with hepatitis B cirrhosis,the differences were statistically significant(p<0.05).With the increase of Child-Pugh grades,the level of FT3 decreased,and the difference was statistically significant(p<0.05).?The levels of FT3,FT4,and TSH were different between the groups of MELD score(<9 points),(10?19 points),and(?20 points)in patients with hepatitis B cirrhosis,the differences were statistically significant(p<0.05).With the increase of the MELD score,the levels of FT3 and TSH decreased,and the differences were statistically significant(p<0.05).?The level of FT3 was positively correlated with the levels of ALB and PLT in patients with hepatitis B cirrhosis(p<0.05),and negatively correlated with the AST,ALP,TBIL,PT,INR,Child-Pugh score and MELD score(p<0.05);FT4 level was positively correlated with ALT,AST,ALP,TBIL,Cr,PT,INR,Child-Pugh score,and MELD score(p<0.05),and negatively correlated with ALB level(p<0.05);TSH level was positively correlated with ALB level(p<0.05),and negatively correlated with ALT,AST,ALP,TBIL,PT,INR,Child-Pugh score,and MELD score(p<0.05).Conclusions1.Patients with hepatitis B cirrhosis have a variety of abnormal thyroid hormone levels,including low FT3,low TSH,high TSH,low FT4,and high FT4.2.Hepatitis B cirrhosis patients have lower FT3 level and higher FT4 level than normal subj ects,but the TSH level is comparative.3.Thyroid hormone levels varied among patients with different severity of cirrhosis,and FT3 level gradually decreased with the increase of liver function severity.The measurement of thyroid hormone levels has important clinical value for the assessment of the severity of hepatitis B cirrhosis.