0 72

Cited 0 times in

간질환 환자의 갑상선 기능

Other Titles
 Thyroid functions in liver disease 
Issue Date
1987
Description
의학과/석사
Abstract
[한글] 간장은 갑상선 호르몬의 말초대사의 가장 중요한 장기의 하나이며 또한 혈중의 T^^4 결합단백을 합성하는 장기이므로 각종 간질환에서 혈중 갑상선 호르몬치의 변화를 초래할 수 있으며 이런 경우 갑상선의 실제 상태를 올바르게 해석하기가 어려운 경우가 있다. 또 한 간질환 환자에서 각종 혈중 갑상선 호르몬치를 측정하여 이중 T^^3, T^^4, T^^3/T^^4, T^^3/FT^^4 및 r-T^^3/T^^3등이 간질환의 중증도를 반영할 수 있다는 보고가 많으나 어느 것이 가장 좋은 지표인지는 아직 확실하지 않다. 이에 본 연구에서는 갑상선 질환이 없었던 각종 간질환환자에서, 간기능검사치와 혈중 갑상선 호르몬치를 측정하여 각종 간질환에서의 혈중 갑상선 호르몬치의 변화양상, 간경변중의 중증도에 따른 혈중 갑상선 호르몬치의 비교 및 간기능검사치와 혈중 갑상선 호르 몬치의 상관관계를 검토하여 다음과 같은 결과를 얻었다. 1) 정상대조군 30예의 혈중 갑상선 호르몬치(평균치±S.D)는 T^^3가 156.92±27.93ng/dl, T^^4 11.44±1.99ug/dl, FT^^4 1.12±0.14ng/ml, TSH 1.23±1.02 μIU/ml, T^^3/T^^4(×100) 13.72±3.24이었다. 2) 각종 간질환중 급성간염, 지방간, 만성지속성간염, 만성활동성간염의 각종 혈중 갑상선호르몬치 및 T^^3/T^^4는 정상대조군에 비해 유의한 차이가 없었다. 3) 간경변중 환자의 혈중 T^^3, T^^4치는 각각 74.45±26.74ng/dl, 5.64±1.83ug/dl로서 정상대조군에 비해 유의하게 감소되어 있었으나 FT^^4, TSH 및 T^^3/T^^4는 각각 0.87±0.62ng/ml, 2.24±2.06μIU/ml, 14.17±7.42로서 정상대조군에 비해 유의한 차이가 없었다. 4) 간암환자 19예에 있어서 혈중 T^^3, T^^4치는 각각 86.05±24.39ng/dl, 9.70±6.26ug/dl로서 정상대조군에 비해 유의하게 감소되어 있었으나 FT^^4, TSH 및 T^^3/T^^4는 각각 0.93±0.37ng/ml, 2.11±1.59 μIU/ml, 12.78±5.69로서 정상대조군에 비해 유의한 차 이가 없었다. 5) 간경변증 환자를 Child씨 기준에 따라 분류하여 각 군간에 혈중 갑상선 호르몬치를 비교한 결과 혈중 T^^3치는 A군 100.73±25.44 ng/dl, B군 76.42±14.40ng/dl, C군 65.18±23.19ng/dl로서 C군에서 A, B군에 비해 유의한 감소를 보였으며 혈중 T^^4치는 A군 6.5 7±1.47μg/dl, B군 6.13±1.12μg/dl, C군 5.27±1.91 μg/dl로서 C군에서 A군에 비해 유의하게 감소되어 있었다. 6) 간경변증 환자에서 간기능검사치와 혈중 T^^3, T^^4치와의 상관관계는 A군에서는 혈중 T^^3 및 T^^4치와 간기능검사치간에 상관관계가 없었고 B군에서는 혈중 T^^3치가 혈중 총단백, 알부민과 유의한 상관관계를 보였으나 혈중 T^^4치는 간기능검사치와 상관관계 가 없었다. C군에서는 혈중 T^^3치는 혈중 총단백, 알부민 및 prothrombin time과 유의한 상관관계가 있었고 혈중 T^^4치는 혈중 총단백, 알부민과 유의한 상관관계가 있었다. 7) 간경변증 환자를 혈중 T^^3치가 80ng/dl미만인 저T^^3군(n=23)과 80∼220ng/dl인 정상 T^^3군(n=15)으로 분류하여 간기능검사치를 비교한 결과 저T^^3군에서 정상T^^3군에 비해 혈중 총단백, 알부민 및 prothrombin time의 유의한 감소를 보였다. 8) 간경변증 환자중 복수가 있는 군과 없는 군간에 혈중 T^^3치를 비교해 본 결과 복수가 있는 군에서 없는 군에 비해 유의하게 감소되어 있었다. 이상을 요약하면 각종 간질환중 간경변증 및 간암에서 혈중 갑상선 호르몬치의 변화가 있었으며 특히 간경변증 환자에서 혈중 T^^3치가 간질환의 중증도를 판단할 수 있는 좋은 지표로 사용할 수 있을 것으로 생각된다.
[영문] The liver has been recognized as an important site in the peripheral metabolism of thyroid hormones particularly in the monodeiodination of thyroxine to triiodothyronine. It is also the source of serum 74 binding proteins. As is to be expected, disease of the liver has marked effects on serum thyroid hormone concentrations and bindings. Nomura et al(1975) reported that liver might be a major site of the peripheral T4 conversion to T3, and extensive liver injury in cirrhosis may significantly reduce T4 conversion to T3 and circulating T3 level. Itoh et al(1986) reported that serum T3, T4 and T3/T4 patio seemed to be useful as a marker of severity of liver diseases. In order to evaluate the change of thyroid hormones in various liver diseases and to elucidate the relationship between thyroid hormone status and severity of lover diseases, both thyroid hormones and liver functions were measured and analyzed in 110 patients with various liver diseases (acute viral hepatitis 14 cases, fatty liver 7 cases, chronic persistent hepatitis 13 cases, fatty liver 7 cases, chronic persistent hepatitis 13 cases, chronic active hepatitis 19 cases, liver cirrhosis 38 cases, and hepatoma 19 cases) who were admitted to Yonsei University Severance Hospital during the period from April 1986 to October 1986. The results were as follows: 1. In various liver diseases, acute hepatitis, fatty liver, chronic persistent hepatitis and chronic active hepatitis showed no significant difference in serum T^^3, T^^4, FT^^4, TSH and T^^3/T^^4 compared to normal controls. 2. The serum T^^3, T^^4, and FT^^4, of 38 liver cirrhosis was 74.45±26.74ng/dl, 5.64±1.83μg/dl and 0.87±0.62ug/ml, respectively. The serum T^^3, T^^4 and FT^^4 of liver cirrhosis were significantly lower than those of control group, but serum TSH and T^^3/T^^4 were within normal limits in liver cirrhosis. 3. The mean serum T^^3 and T^^4 in 19 patients of hepatoma was 86.05±24.39ng/dl and 9.70±6.26ug/dl, respectively. The serum T^^3 and T^^4 of hepatoma was significantly lower han those of control group, but mean serum FT^^ 4, TSH and T^^3/T^^4 showed no significant difference between hepatoma and control groups. 4. The mean serum T^^3 level of seven patients with Child's class A was 100.73±25.44ng/dl, thirteen patients with class B 76.42±14.40ng/dl, and eighteen patients of class C 65.18±23.19ng/dl. There was a significant statistical difference among Child's class A, B and C. 5. There was no significant correlation between serum T^^3 and liver functions in Child's class A of liver cirrhosis. Serum T^^3 was significantly correlated with total protein and albumin in Child's class B, with total protein, albumin and prothrombin time in Child class's C. 6. In liver cirrhosis, low serum T^^3 group(T^^3 < 80ng/dl) had a significant decrease in total protein, albumin and prolonged prothrombin tome than normal serum T^^3 group(80ng/dl<T^^3<220ng/dl). 7. Serum T^^3 decreased significantly in liver cirrhosis with ascites than in those without ascites. In conclusions in liver cirrhosis and hepatoma, significant decrease in serum T^^3 and T^^4 level were observed and particularly serum T^^3 level may be useful in assessing the severity of hepatocellular damage in liver cirrhosis. The liver has been recognized as an important site in the peripheral metabolism of thyroid hormones particularly in the monodeiodination of thyroxine to triiodothyronine. It is also the source of serum 74 binding proteins. As is to be expected, disease of the liver has marked effects on serum thyroid hormone concentrations and bindings. Nomura et al(1975) reported that liver might be a major site of the peripheral T4 conversion to T3, and extensive liver injury in cirrhosis may significantly reduce T4 conversion to T3 and circulating T3 level. Itoh et al(1986) reported that serum T3, T4 and T3/T4 patio seemed to be useful as a marker of severity of liver diseases. In order to evaluate the change of thyroid hormones in various liver diseases and to elucidate the relationship between thyroid hormone status and severity of lover diseases, both thyroid hormones and liver functions were measured and analyzed in 110 patients with various liver diseases (acute viral hepatitis 14 cases, fatty liver 7 cases, chronic persistent hepatitis 13 cases, fatty liver 7 cases, chronic persistent hepatitis 13 cases, chronic active hepatitis 19 cases, liver cirrhosis 38 cases, and hepatoma 19 cases) who were admitted to Yonsei University Severance Hospital during the period from April 1986 to October 1986. The results were as follows: 1. In various liver diseases, acute hepatitis, fatty liver, chronic persistent hepatitis and chronic active hepatitis showed no significant difference in serum T^^3, T^^4, FT^^4, TSH and T^^3/T^^4 compared to normal controls. 2. The serum T^^3, T^^4, and FT^^4, of 38 liver cirrhosis was 74.45±26.74ng/dl, 5.64±1.83μg/dl and 0.87±0.62ug/ml, respectively. The serum T^^3, T^^4 and FT^^4 of liver cirrhosis were significantly lower than those of control group, but serum TSH and T^^3/T^^4 were within normal limits in liver cirrhosis. 3. The mean serum T^^3 and T^^4 in 19 patients of hepatoma was 86.05±24.39ng/dl and 9.70±6.26ug/dl, respectively. The serum T^^3 and T^^4 of hepatoma was significantly lower than those of control group, but mean serum FT^^4, TSH and T^^3/T^^4 showed no significant difference between hepatoma and control groups. 4. The mean serum T^^3 level of seven patients with Child's class A was 100.73±25.44ng/dl, thirteen patients with class B 76.42±14.40ng/dl, and eighteen patients of class C 65.18±23.19ng/dl. There was a significant statistical difference among Child's class A, B and C. 5. There was no significant correlation between serum T^^3 and liver functions in Child's class A of liver cirrhosis. Serum T^^3 was significantly correlated with total protein and albumin in Child's class B, with total protein, albumin and prothrombin time in Child class's C. 6. In liver cirrhosis, low serum T^^3 group(T^^3 < 80ng/dl) had a significant decrease in total protein, albumin and prolonged prothrombin tome than normal serum T^^3 group(80ng/dl<T^^3<220ng/dl). 7. Serum T^^3 decreased significantly in liver cirrhosis with ascites than in those without ascites. In conclusions in liver cirrhosis and hepatoma, significant decrease in serum T^^3 and T^^4 level were observed and particularly serum T^^3 level may be useful in assessing the severity of hepatocellular damage in liver cirrhosis.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117070
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
사서에게 알리기
  feedback
Fulltext
비공개 원문입니다.
Export
RIS (EndNote)
XLS (Excel)
XML

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse