7例甲状腺功能亢进症合并重度黄疸患者临床特点分析

郑小勤; 李丽; 靳华; 勾春燕; 汪晓军

doi:10.3969/j.issn.1001-5256.2021.06.036

7例甲状腺功能亢进症合并重度黄疸患者临床特点分析

DOI: 10.3969/j.issn.1001-5256.2021.06.036

首都医科大学附属北京佑安医院中西医结合科，北京 100069

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：郑小勤负责收集数据，资料分析，拟定写作思路，撰写论文；李丽负责课题设计, 修改写作思路；靳华负责收集数据，资料分析；勾春燕负责修改论文；汪晓军负责指导撰写文章并最后定稿。

详细信息

作者简介:
郑小勤(1986—)，女，主要从事感染与传染性疾病的研究

通信作者:
汪晓军，w_xiaojun@ccmu.edu.cn

中图分类号: R575; R581.1
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- 文章访问数: 426
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- PDF下载量: 43
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-09
- 录用日期: 2020-12-22
- 出版日期: 2021-06-20

Clinical features of hyperthyroidism with severe jaundice: An analysis of seven cases

Department of Integrated Traditional Chinese and Western Medicine, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China

摘要

- 甲状腺功能亢进症 /
- 黄疸 /
- 诊断 /
- 治疗学
- Hyperthyroidism /
- Jaundice /
- Diagnosis /
- Therapeutics

HTML全文

表 1 7例甲亢合并重度黄疸患者的基本资料

病例	性别	年龄(岁)	甲亢病程(月)	甲亢表现	既往抗甲亢治疗	甲亢其余脏器受累
1	男	41	48	无	PTU	无
2	女	44	1	腹泻	无	无
3	男	29	1	无	无	无
4	男	54	240	无	¹³¹I	无
5	男	50	72	心慌	MMI 普萘洛尔地高辛	甲亢性心脏病房颤心力衰竭
6	女	55	10	手抖心慌消瘦	¹³¹I	甲亢性心脏病心力衰竭
7	女	22	36	突眼手抖心慌	无	甲亢性心脏病房颤心力衰竭

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表 2 7例甲亢合并重度黄疸患者的确诊时间、治疗方案及转归

病例	确诊时间(d)	治疗方案	转归
1	14	MMI	好转
2	1	PTU	好转
3	60	甲泼尼龙+胆红素吸附+¹³¹I	好转
4	20	胆红素吸附	好转
5	10	MMI+普萘洛尔+胆红素吸附	好转
6	8	MMI+普萘洛尔+胆红素吸附	好转
7	120	普萘洛尔	不详，自动出院

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表 3 7例甲亢合并重度黄疸患者治疗前后肝损伤及甲亢相关指标

实验室检查	治疗前(n=7)	治疗后(n=6)
肝损伤相关指标
ALT(U/L)	78.0(22.0~122.0)	18.0(10.7~29.5)
AST(U/L)	69.2±34.9	29.1±12.2
TBil(μmol/L)	623.3(398.8~741.0)	54.6(34.6~167.1)
DBil(μmol/L)	437.9(274.9~540.0)	45.5(14.9~127.6)
ALP(U/L)	197.1±78.6	148.1±45.9
GGT(U/L)	59.0(44.0~78.0)	54.0(24.5~55.3)
PT(s)	15.4±3.8	12.8±3.5
INR	1.3±0.3	1.1±0.3
PTA(%)	71.0±34.2	92.5±32.2
NH₃(μg/dl)	89.0(59.0~100.0)	55.0(40.0~96.0)
甲亢相关指标
FT3(pmol/L)	6.7(0~15.7)	6.7(4.7~11.1)
FT4(pmol/L)	25.1(0~52.2)	18.4(11.9~33.1)
TSH(mIU/L)	＜0.002 5	0.001 7±0.004 0
TGAb(IU/ml)	56.1(7.5~473.8)	-
TRAb(IU/L)	20.4(3.8~33.8)	-
TPOAb(IU/ml)	204.5(47.4~552.2)	-
注：-，因样本量少，无法计算中位数。

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表 4 7例甲亢合并重度黄疸患者感染情况及诊断依据

病例	合并感染	诊断依据
1	腹腔感染	右下腹压痛(+)，WBC 13.78×10⁹/L，中性粒细胞百分比81.2%
2	胆系感染，腹腔感染	上腹痛，Murphy征(+)，腹膜刺激征(+)，降钙素原0.46 ng/ml
3	无	无
4	腹腔感染，血流感染	下腹部压痛、反跳痛(+)，移动性浊音(±)，血培养为金黄色葡萄球菌
5	肺部感染	高热，双肺呼吸音粗，WBC 9.15×10⁹/L，中性粒细胞百分比82.6%，胸部CT提示双肺炎症可能
6	肺部感染，真菌感染，泌尿系感染	尿道口隐痛，真菌(1-3)-β-D葡聚糖796.5 pg/ml，降钙素原1.16 ng/ml，胸部CT提示双肺炎症可能，痰涂片、便涂片可见真菌
7	胆系感染	发热，Murphy征(+)，WBC 12.69×10⁹/L，中性粒细胞百分比87%

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