Analysis Of Risk Factors Associated With Hyperthyroidism Liver Injury Caused By Graves Disease

ObjectiveIt is very common to have liver damage in patients with hyperthyroidism in clinical practice.This article analyzes the clinical features,thyroid function and liver function of patients with hyperthyroidism liver injury caused by Graves disease;discusses the risk factors for predicting hyperthyroidism liver injurycaused by Graves disease;and analyzing Graves Correlation between liver function indicators and thyroid function and thyroid autoantibodies in patients.In order to attract the attention of clinicians.Methods1.Case collection:Patients with Graves disease who were hospitalized in the endocrine disease area of Linyi People's Hospital of Shandong Province from January 2017 to August 2018were collected.All patients enrolled met the diagnostic criteria for Graves' disease in the Chinese Guidelines for the Diagnosis and Treatment of Thyroids(2007 Edition).Exclude liver damage caused by other causes:including various types of viral hepatitis,anti-thyroid drugs(ATD)treatment,cardiovascular complications,combined with autoimmune liver disease,drug-induced hepatitis,non-alcoholic fatty liver disease,excessive drinking and other factors.A total of 489 cases were collected.2.Clinical data collection:collection of basic conditions(sex,age,height and weight,BMI),age of onset,course of disease,history of smoking,history of drinking,past medical history,thyroid size,24-hour iodine absorption rate,liver color Doppler,cardiac color Doppler,thyroid function indicators(FT3,FT4,TSH),thyroid autoantibody indicators(TPOAb,TGAb,TRAb)and liver function indicators(ALT,AST,ALP,y-GT,TBIL,DBIL,IBIL,TP,ALB,A/G),etc.3.Statistical analysis:According to whether there were 1 or more liver function abnormalities,the enrolled patients were classified into normal liver function group(group A)and liver function abnormal group(group B).Statistical analysis of the general condition,thyroid function and liver function of the patients between the two groups;analysis of risk factors associated with hyperthyroidism liver injury caused by Graves disease;And to analyze the relationship between liver function indicators and thyroid function indicators and thyroid autoantibodies in patients with Graves disease.The above data were statistically analyzed using SPSS20.0 software.Results1.Of the 489 patients with Graves' disease,316(64.6%)had abnormal liver function,hyperthyroidism liver injury occurred,and 173(35.7%)had normal liver function.The proportion of male patients with abnormal liver function was significantly higher than that of normal liver function group,and the course of disease was shorter than that of normal liver function group.The FT3,FT4 and TRAb of liver function abnormal group were significantly higher than those of normal liver function group.Significant statistical significance;The liver function indexes of the two groups were compared.The AST,ALT,ALP,y-GT,TBIL,DBIL and IBIL of the liver function abnormal group were significantly higher than those of the normal liver function group.The TP and ALB were significantly lower than the normal liver function group.There are significant statistical differences.2.The incidence of abnormal liver function indexes in patients with hyperthyroidism liver injury caused by Graves disease was as follows:ALT:53.8%,AST:41.8%,ALP:38.9%,?-GT:31.6%,DBIL:14.9%,TP:12.0%,TBIL:10.8%,IBIL:9.8%,ALB:2.8%,A/G:1.9%.3.Male and FT4 in patients with Graves disease are independent risk factors for hyperthyroidism liver injury caused by Graves disease.The OR values were 2.434(95%CI:1.375-4.310),1.020(95%CI:1.011-1.028),and P was 0.002,with statistically significant differences.Based on the ROC curve of FT4,the optimal threshold of FT4 was found to be 42.33 pmol/L,and the sensitivity and specificity were 66.8%and 54.9%,respectively;the area under the curve(AUC)was:0.645;95%Cl:(0.595,0.696),P<0.001.4.Correlation between liver function indexes and thyroid function and thyroid autoantibodies in patients with Graves disease:AST was positively correlated with FT4,and negatively correlated with disease course and TPOAb;ALT was positively correlated with FT4 and negatively correlated with disease course and TPOAb;ALP was positively correlated with FT4,TPOAb and TRAb,and negatively correlated with age;?-GT was positively correlated with age and negatively correlated with disease duration;TBIL was positively correlated with FT3,FT4 and TRAb;DBIL was positively correlated with FT3,FT4 and TRAb,and negatively correlated with age;IBIL was positively correlated with TRAb;TP was positively correlated with disease duration and negatively correlated with FT3 and FT4.Conclusions1.Hyperthyroidism liver injury caused by Graves disease is more common in clinical,The incidence rate was 64.6%.Most patients had mild liver dysfunction.2.FT3,FT4 and TRAb in patients with liver function abnormal group were significantly higher than those in normal liver function group,FT3,FT4 and TRAb in patients with Graves disease were positively correlated with liver function transaminase and bilirubin,and negatively correlated with TP.It is suggested that the severity of hyperthyroidism liver injury caused by Graves disease may be related to the severity of thyroid dysfunction in patients.3.Through logistic regression analysis,it was found that the independent risk factors for hyperthyroidism liver injury caused by Graves disease were male patients and FT4,The OR values were 2.434(95%CI:1.375-4.310)and 1.020(95%CI:1.011-1.028).Based on the ROC curve of FT4,the optimal threshold of FT4 was 42.33 pmol/L,and the sensitivity and specificity were 66.8%and 54.9%,respectively.