肝衰竭患者能量代谢与血清甲状腺激素水平的相关性及其对预后的影响

刘兴; 孔明; 华鑫; 杨银川; 徐曼曼; 毕研贞; 李璐; 段钟平; 陈煜

doi:10.3969/j.issn.1001-5256.2023.01.020

肝衰竭患者能量代谢与血清甲状腺激素水平的相关性及其对预后的影响

DOI: 10.3969/j.issn.1001-5256.2023.01.020

刘兴¹,
孔明^{2a, 3},
华鑫^2b,
杨银川^2a,
徐曼曼^2a,
毕研贞⁴,
李璐^2a,
段钟平^{2a, 3},
陈煜^{2a, 3, , ,}

1.
临沂市人民医院感染科，山东临沂 276000
2a.
首都医科大学附属北京佑安医院肝病中心四科，北京 100069
2b.
首都医科大学附属北京佑安医院营养科，北京 100069
3.
北京市肝衰竭与人工肝治疗研究重点实验室，北京 100069
4.
青岛市立医院感染科，山东青岛 266011

基金项目:

佑安肝病感染病专科医疗联盟科研专项 (LM202011);

北京市自然科学基金 (7222094)

伦理学声明：本研究于2016年8月30日经首都医科大学附属北京佑安医院伦理委员会批准，批号：京佑科伦字(2016)18号。

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：刘兴负责研究实施，分析数据，撰写论文；华鑫、杨银川、毕研贞、李璐负责研究实施，收集数据；徐曼曼负责分析数据，审核结果；孔明、段钟平、陈煜负责研究设计，审核结果及论文。

详细信息

通信作者:
陈煜，chybeyond1071@ccmu.edu.cn(ORCID: 0000-0003-1906-7486)

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出版历程
- 收稿日期: 2022-06-06
- 录用日期: 2022-07-20
- 出版日期: 2023-01-20

Association of energy metabolism with serum thyroid hormone levels in patients with liver failure and their impact on prognosis

Xing LIU¹,
Ming KONG^{2a, 3},
Xin HUA^2b,
Yinchuan YANG^2a,
Manman XU^2a,
Yanzhen BI⁴,
Lu LI^2a,
Zhongping DUAN^{2a, 3},
Yu CHEN^{2a, 3
, ,
,}

1.
Department of Infectious Disease, Linyi People's Hospital, Linyi, Shandong 276000, China
2a.
Fourth Department of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
2b.
Department of Clinical Nutrition, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
3.
Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing 100069, China
4.
Department of Infectious Disease, Qingdao Municipal Hospital, Qingdao, Shandong 266011, China

Research funding:

Special Research Fund of Youan Medical Alliance for the Liver and Infectious Diseases (LM202011);

Beijing Municipal Natural Science Foundation (7222094)

More Information

Corresponding author: CHEN Yu, chybeyond1071@ccmu.edu.cn (ORCID: 0000-0003-1906-7486)

摘要

摘要: 目的探讨肝衰竭患者终末期肝病模型(MELD)评分、能量代谢与血清甲状腺激素水平的相关性以及对病情及预后的预测价值。方法选取2016年11月—2019年4月在首都医科大学附属北京佑安医院肝病中心四科住院的60例肝衰竭患者并随访分为死亡组(23例)和存活组(37例)，检测能量代谢及甲状腺功能等指标进行比较分析。两组连续变量的比较，符合正态分布的采用独立样本t检验，非正态分布的采用Mann-Whitney U检验；分类变量两组间比较采用χ²检验。采用Spearman相关系数评价各指标的相关性。受试者工作特征(ROC)曲线分析血清总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)水平预测肝衰竭患者预后的最佳分界点。结果所有肝衰竭患者低TT3和低FT3的发生率为分别为78.2%和69.1%，死亡组和存活组的低TT3发生率分别为95.2%和67.6%，低FT3的发生率分别为90.5%和55.9%，差异均具有统计学意义(P值均＜0.05)。死亡组的MELD评分显著高于存活组[26.0(21.0~29.0)vs 21.0(19.0~24.0), Z=-3.369, P=0.001]，而血清TT3、FT3水平显著低于存活组[0.69(0.62~0.73) vs 0.83(0.69~0.94)、2.17(1.99~2.31) vs 2.54(2.12~2.86)，Z值分别为-2.884、-2.876，P值均＜0.01]。MELD评分与血清TT3、FT3、促甲状腺激素(TSH)水平及呼吸商(RQ)呈负相关(r值分别为-0.487、-0.329、-0.422、-0.350，P值均＜0.01)，RQ与血清TT3、FT3水平呈正相关(r值分别为0.271、0.265，P值均＜0.05)。通过血清TT3、FT3水平预测肝衰竭患者生存预后的最佳分界点分别为0.75 nmol/L、2.37 pmol/L，其敏感度分别为67.6%、64.7%, 特异度分别为90.5%、81.0%。结论肝衰竭患者可出现异常能量代谢状态导致呼吸商降低，并可出现甲状腺激素水平的异常，对评估肝衰竭患者病情严重程度及预后具有潜在的临床应用价值。
- 肝功能衰竭 /
- 能量代谢 /
- 甲状腺素 /
- 预后
Abstract: Objective To explore the predictive value of the model for end-stage liver disease (MELD) score, energy metabolism and serum thyroid hormone levels on the severity and prognosis of patients with liver failure and their correlation. Methods This study collected clinicopathological data from 60 liver failure patients, e.g., end-stage liver disease (MELD) score, energy metabolism, and serum thyroid hormone levels. The χ² test was performed to analyze the categorical variables, while the Mann-Whitney U test and independent sample t test were performed to assess the continuous variables between the two groups. Spearman correlation coefficient test was used to evaluate correlation of each index. The receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off points of serum total triiodothyronine (TT3) and free triiodothyronine (FT3) levels in predicting prognosis of the patients. Results The rates of low TT3 and FT3 levels in liver failure patients were 78.2% and 69.1%, respectively, whereas the low TT3 rates were 95.2% and 67.6% and the low FT3 rates were 90.5% and 55.9% in survival and non-survival groups of patients, respectively (both P < 0.05). Moreover, the MELD score was significantly higher in the non-survival patients than in survival patients [26.0(21.0-29.0) vs 21.0 (19.0-24.0), Z=-3.396, P=0.001], while TT3 and FT3 levels were significantly lower in the non-survival patients than in the survival patients [0.69(0.62-0.73) vs 0.83(0.69-0.94) and 2.17(1.99-2.31) vs 2.54(2.12-2.86), respectively; Z=-2.884、-2.876, all P < 0.01]. The MELD score was negatively associated with serum TT3, FT3, and thyroid stimulating hormone (TSH) levels and the respiratory quotient (RQ) (r=-0.487、-0.329、-0.422、-0.350, all P < 0.01), whereas the RQ was associated with serum TT3 and FT3 levels (r=0.271、0.265, all P < 0.05). The optimal cutoff values in predicting the severity and survival of patients was 0.75 nmol/L and 2.37pmol/L with the sensitivity values of 67.6% and 64.7% and the specificity of 90.5% and 81.0%, respectively. Conclusion Abnormal thyroid hormone levels and low respiratory quotient could be used to predict the severity and prognosis of patients with liver failure.
- Liver Failure /
- Energy Metabolism /
- Thyroxine /
- Prognosis

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图 1 肝衰竭患者血清TT3、FT3水平的ROC曲线

Figure 1. ROC curve of serum TT3 and FT3 levels in patients with liver failure

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表 1 患者的基线特征比较

Table 1. Comparison of baseline characteristics of patients

指标	死亡组(n=23)	存活组(n=37)	统计值	P值
年龄(岁)	46.7±13.4	43.0±12.8	t=1.064	0.292
男性[例(%)]	18(78.3)	32(86.5)	χ²=0.226	0.635
MELD评分	26.0(21.0~29.0)	21.0(19.0~24.0)	Z=-3.369	0.001
RQ	0.78(0.73~0.80)	0.80(0.77~0.85)	Z=-1.905	0.057
REE(kcal/d)	1473(1159~1637)	1528(1378~1641)	Z=-1.300	0.194
TT3(nmol/L)	0.69(0.62~0.73)	0.83(0.69~0.94)	Z=-2.886	0.004
TT4(nmol/L)	56.34(44.47~67.00)	74.35(45.15~111.45)	Z=-1.819	0.069
FT3(pmol/L)	2.17(1.99~2.31)	2.54(2.12~2.86)	Z=-2.876	0.004
FT4(pmol/L)	11.80(10.92~13.99)	12.90(10.61~15.91)	Z=-0.901	0.368
TSH(mIU/L)	0.35(0.07~1.98)	0.34(0.16~1.49)	Z=-0.251	0.802
低TT3[例(%)]¹⁾	20(95.2)	23(67.6)	χ²=4.289	0.038
低FT3[例(%)]¹⁾	19(90.5)	19(55.9)	χ²=7.275	0.007
注：1)低TT3、低FT3指低于检测正常值下限，死亡组和存活组分别有2例和3例缺失值。

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表 2 MELD评分、RQ、甲状腺激素水平之间的相关性分析

Table 2. Correlation analysis among MELD score, RQ and thyroid hormone levels

指标	统计值	MELD评分	RQ	TT3	TT4	FT3	FT4	TSH
MELD评分	r值	-	-0.350	-0.487	-0.121	-0.329	0.010	-0.422
	P值	-	＜0.001	＜0.001	0.281	0.003	0.927	＜0.001
RQ	r值	-	-	0.271	-0.004	0.265	-0.171	0.125
	P值	-	-	0.018	0.976	0.022	0.143	0.284
REE	r值	0.073	0.052	0.141	0.021	0.064	0.020	-0.053
	P值	0.470	0.607	0.228	0.859	0.585	0.868	0.653

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