甲状腺功能减退对慢性肝病的影响

刘欢; 陈鹏; 李菲

doi:10.3969/j.issn.1001-5256.2021.04.054

甲状腺功能减退对慢性肝病的影响

DOI: 10.3969/j.issn.1001-5256.2021.04.054

天津市第二人民医院慢性肝病科，天津 300192

基金项目:

国家科技部“十三五”重大专项 (2017ZX10203201-007)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：刘欢、陈鹏对研究的思路及起草文章有关键贡献；李菲参与了修改文章关键内容。

详细信息

作者简介:
刘欢(1982—)，女，主治医师，主要从事肝病相关临床研究

通信作者:
李菲，huanhuan20062501@126.com

中图分类号: R575
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- 被引次数: 0
出版历程
- 收稿日期: 2020-09-25
- 录用日期: 2020-10-22
- 出版日期: 2021-04-20

Effect of hypothyroidism on chronic liver diseases

Department of Chronic Liver Diseases, Tianjin Second People's Hospital, Tianjin 300192, China

摘要

摘要: 正常生理状态下，肝脏在甲状腺激素的代谢、降解和排泄过程中发挥着重要作用。但当肝脏发生病变时，甲状腺功能减退现象明显增加，且多数患者无明显临床症状及体征。归纳了由于各种病因引起的慢性肝病及其不同发病阶段患者甲状腺功能水平的变化，发现甲状腺激素水平的下降对预测慢性肝病发生风险、病情判断及预后评估具有重要的指导价值。研究认为部分慢性肝病患者可通过甲状腺功能的调节，进而在一定程度上起到缓解病情、改善预后的治疗效果。此外，由于甲状腺代谢异常所引发的一系列基因失调或功能紊乱有可能成为部分慢性肝病新的治疗靶点，结论有待进一步研究证实。
- 肝疾病 /
- 甲状腺功能减退症 /
- 甲状腺激素类
Abstract: The liver plays an important role in the metabolism, degradation, and excretion of thyroid hormones in the normal physiological state; however, when liver injuries occur, there is a significance increase in hypothyroidism, and most patients have no obvious clinical symptoms or signs. The article summarizes the chronic liver diseases caused by various etiologies and the change in thyroid function in different stages of disease and points out that the reduction in the level of thyroid hormone has an important value in predicting the risk, condition, and prognosis of chronic liver diseases. Studies have shown that some patients with chronic liver diseases can improve the condition and prognosis by adjusting thyroid function. In addition, a series of genetic disorders or dysfunctions caused by abnormal thyroid metabolism may become new therapeutic targets for certain chronic liver diseases, which needs to be confirmed by further studies.
- Liver Diseases /
- Hypothyroidism /
- Thyroid Hormones

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参考文献(46)

[1]	PIANTANIDA E, IPPOLITO S, GALLO D, et al. The interplay between thyroid and liver: Implications for clinical practice[J]. J Endocrinol Invest, 2020, 43(7): 885-899. DOI: 10.1007/s40618-020-01208-6.
[2]	LIU Y, WANG W, YU X, et al. Thyroid function and risk of non-alcoholic fatty liver disease in euthyroid subjects[J]. Ann Hepatol, 2018, 17(5): 779-788. DOI: 10.5604/01.3001.0012.3136.
[3]	MANKA P, COOMBES JD, BOOSMAN R, et al. Thyroid hormone in the regulation of hepatocellular carcinoma and its microenvironment[J]. Cancer Lett, 2018, 419: 175-186. DOI: 10.1016/j.canlet.2018.01.055.
[4]	XU SJ, FAN JX, YANG S, et al. Variations in different thyroid stimulating hormone and free thyroxine detection kits for evaluating thyroid function during pregnancy[J]. Chin J Perinat Med, 2015, 18(2): 81-86. DOI: 10.3760/cma.j.issn.1007-9408.2015.02.001. 许诗珺, 范建霞, 杨帅, 等. 不同促甲状腺激素和游离甲状腺素检测试剂对妊娠期甲状腺功能检测结果的影响[J]. 中华围产医学杂志, 2015, 18(2): 81-86. DOI: 10.3760/cma.j.issn.1007-9408.2015.02.001.
[5]	QIU Q, HAN YJ, SHEN J, et al. Correlation study of gestational diabetes mellitus and thyroid function[J]. Chin J Diabetes, 2017, 25(4): 308-311. DOI: 10.3969/j.issn.1006-6187.2017.04.005. 邱情, 韩亚娟, 沈洁, 等. 妊娠期糖尿病与妊娠期甲状腺功能状态的相关性分析[J]. 中国糖尿病杂志, 2017, 25(4): 308-311. DOI: 10.3969/j.issn.1006-6187.2017.04.005.
[6]	LLEO A, MARZORATI S, ANAYA JM, et al. Primary biliary cholangitis: A comprehensive overview[J]. Hepatol Int, 2017, 11(6): 485-499. DOI: 10.1007/s12072-017-9830-1.
[7]	KOWALIK MA, COLUMBANO A, PERRA A. Thyroid hormones, thyromimetics and their metabolites in the treatment of liver disease[J]. Front Endocrinol(Lausanne), 2018, 9: 382. DOI: 10.3389/fendo.2018.00382.
[8]	GLUVIC Z, ZARIC B, RESANOVIC I, et al. Link between metabolic syndrome and insulin resistance[J]. Curr Vasc Pharmacol, 2017, 15(1): 30-39. DOI: 10.2174/1570161114666161007164510.
[9]	YOUNOSSI ZM, KOENIG AB, ABDELATIF D, et al. Globalepidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64(1): 73-84. DOI: 10.1002/hep.28431.
[10]	FUCHS CD, CLAUDEL T, TRAUNER M. Role of metabolic lipases and lipolytic metabolites in the pathogenesis of NAFLD[J]. Trends Endocrinol Metab, 2014, 25(11): 576-585. DOI: 10.1016/j.tem.2014.08.001.
[11]	ZHU JZ, YI HW, HUANG W, et al. Fatty liver diseases, mechanisms, and potential therapeutic plant medicines[J]. Chin J Nat Med, 2020, 18(3): 161-168. DOI: 10.1016/S1875-5364(20)30017-0.
[12]	VYAKARANAM S, VANAPARTHY S, NORI S, et al. Study of insulin resistance in subclinical hypothyroidism[J]. Int J Health Sci Res, 2014, 4(9): 147-153.
[13]	PAGADALA MR, ZEIN CO, DASARATHY S, et al. Prevalence of hypothyroidism in nonalcoholic fatty liver disease[J]. Dig Dis Sci, 2012, 57(2): 528-534. DOI: 10.1007/s10620-011-2006-2.
[14]	TAHARA K, AKAHANE T, NAMISAKI T, et al. Thyroid-stimulating hormone is an independent risk factor of non-alcoholic fatty liver disease[J]. JGH Open, 2020, 4(3): 400-404. DOI: 10.1002/jgh3.12264.
[15]	RITTER MJ, AMANO I, HOLLENBERG AN. Thyroid hormone signaling and the liver[J]. Hepatology, 2020, 72(2): 742-752. DOI: 10.1002/hep.31296.
[16]	KIM D, YOO ER, LI AA, et al. Low-normal thyroid function is associated with advanced fibrosis among adults in the united states[J]. Clin Gastroenterol Hepatol, 2019, 17(11): 2379-2381. DOI: 10.1016/j.cgh.2018.11.024.
[17]	JARUVONGVANICH V, SANGUANKEO A, UPALA S. Nonalcoholic fatty liver disease is not associated with thyroid hormone levels and hypothyroidism: A systematic review and meta-analysis[J]. Ear Thyroid J, 2017, 6(4): 208-215. DOI: 10.1159/000454920.
[18]	HE WW, AN XF, LEE L, et al. Relationship between hypothyroidism and non-alcoholic fatty liver disease: A systematic review and meta-analysis[J]. Front Endocrinol (Lausanne), 2017, 8: 335. DOI: 10.3389/fendo.2017.00335.
[19]	NHO KW, KIM YH, HAN DJ, et al. Kidney transplantation alone in end-stage renal disease patients with hepatitis B liver cirrhosis: A single-center experience[J]. Transplantation, 2015, 99(1): 133-138. DOI: 10.1097/TP.0000000000000234.
[20]	LIU L, LI P, MI Y, et al. Thyroid-stimulating hormone is associated with nonalcoholic steatohepatitis in patients with chronic hepatitis B[J]. Medicine (Baltimore), 2019, 98(46): e17945. DOI: 10.1097/MD.0000000000017945.
[21]	BANO A, CHAKER L, MUKA T, et al. Thyroid function and the risk of fibrosis of the liver, heart, and lung in humans: A systematic review and meta-analysis[J]. Thyroid, 2020, 30(6): 806-820. DOI: 10.1089/THY.2019.0572.
[22]	PUNEKAR P, SHARMA AK, JAIN A. A study of thyroid dysfunction in cirrhosis of liver and correlation with severity of liver disease[J]. Indian J Endocrinol Metab, 2018, 22(5): 645-650. DOI: 10.4103/ijem.IJEM-25-18.
[23]	CACOUB P, RATZIU V, MYERS RP, et al. Impact of treatment on extra hepatic manifestations in patients with chronic hepatitis C[J]. J Hepatol, 2002, 36(6): 812-818. DOI: 10.1016/s0168-8278(02)00067-3.
[24]	AKENO N, BLACKARD JT, TOMER Y. HCV E2 protein binds directly to thyroid cells and induces IL-8 production: A new mechanism for HCV induced thyroid autoimmunity[J]. J Autoimmun, 2008, 31(4): 339-344. DOI: 10.1016/j.jaut.2008.08.001.
[25]	PASTORE F, MARTOCCHIA A, STEFANELLI M, et al. Hepatitis C virus infection and thyroid autoimmune disorders: A model of interactions between the host and the environment[J]. World J Hepatol, 2016, 8(2): 83-91. DOI: 10.4254/wjh.v8.i2.83.
[26]	CARELLA C, MAZZIOTTI G, AMATO G, et al. Clinical review 169: Interferon-alpha-related thyroid disease: Pathophysiological, epidemiological, and clinical aspects[J]. J Clin Endocrinol Metab, 2004, 89(8): 3656-3661. DOI: 10.1210/jc.2004-0627.
[27]	ROTI E, MINELLI R, GIUBERTI T, et al. Multiple changes in thyroid function in patients with chronic active HCV hepatitis treated with recombinant interferon-alpha[J]. Am J Med, 1996, 101(5): 482-487. DOI: 10.1016/s0002-9343(96)00259-8.
[28]	BERRIS B, FEINMAN SV. Thyroid dysfunction and liver injury following alpha-interferon treatment of chronic viral hepatitis[J]. Dig Dis Sci, 1991, 36(11): 1657-1660. DOI: 10.1007/BF01296413.
[29]	DALGARD O, BJØRO K, HELLUM K, et al. Thyroid dysfunction during treatment of chronic hepatitis C with interferon alpha: No association with either interferon dosage or efficacy of therapy[J]. J Intern Med, 2002, 251(5): 400-406. DOI: 10.1046/j.1365-2796.2002.00974.x.
[30]	BAUDIN E, MARCELLIN P, POUTEAU M, et al. Reversibility of thyroid dysfunction induced by recombinant alpha interferon in chronic hepatitis C[J]. Clin Endocrinol (Oxf), 1993, 39(6): 657-661. DOI: 10.1111/j.1365-2265.1993.tb02423.x.
[31]	MARAZUELA M, GARCÍA-BUEY L, GONZÁLEZ-FERNÁNDEZ B, et al. Thyroid autoimmune disorders in patients with chronic hepatitis C before and during interferon-alpha therapy[J]. Clin Endocrinol (Oxf), 1996, 44(6): 635-642. DOI: 10.1046/j.1365-2265.1996.751768.x.
[32]	VASILIADIS T, ANAGNOSTIS P, NALMPANTIDIS G, et al. Thyroid dysfunction and long-term outcome during and after interferon-alpha therapy in patients with chronic hepatitis C[J]. Ann Acad Med Singap, 2011, 40(9): 394-400. http://www.ncbi.nlm.nih.gov/pubmed/22065032
[33]	XU H, NIU Q, SU Z, et al. Genetic association of E26 transformation specific sequence 1 polymorphisms with the susceptibility of primary biliary cholangitis in China[J]. Sci Rep, 2019, 9(1): 19680. DOI: 10.1038/s41598-019-56181-9.
[34]	CHALIFOUX SL, KONYN PG, CHOI G, et al. Extrahepatic manifestations of primary biliary cholangitis[J]. Gut Liver, 2017, 11(6): 771-780. DOI: 10.5009/gnl16365.
[35]	ALVARADO TF, PULIGA E, PREZIOSI M, et al. Thyroid hormone receptor β agonist induces β-catenin-dependent hepatocyte proliferation in mice: Implications in hepatic regeneration[J]. Gene Expr, 2016, 17(1): 19-34. DOI: 10.3727/105221616X691631.
[36]	KOSAR K, CORNUET P, SINGH S, et al. The thyromimetic sobetirome (GC-1) alters bile acid metabolism in a mouse model of hepatic cholestasis[J]. Am J Pathol, 2020, 190(5): 1006-1017. DOI: 10.1016/j.ajpath.2020.01.015.
[37]	GAO XY, GUO CH, ZHU W, et al. Study on the abnormal thyroliberin and related factors in patients with acute hepatic failure related encephpathy of type A hepatitis and its related influencing factors[J]. J Clin Exp Med, 2019, 18(3): 274-277. DOI: 10.3969/j.issn.1671-4695.2019.03.014. 高秀莹, 郭彩红, 朱巍, 等. 急性肝衰竭相关A型肝性脑病患者促甲状腺激素的异常及其相关影响因素[J]. 临床和实验医学杂志, 2019, 18(3): 274-277. DOI: 10.3969/j.issn.1671-4695.2019.03.014.
[38]	THOBE N, PILGER P, JONES MP. Primary hypothyroidism masquerading as hepatic encephalopathy: Case report and review of the literature[J]. Postgrad Med J, 2000, 76(897): 424-426. DOI: 10.1136/pmj.76.897.424.
[39]	KHAIRY RN, MULLEN KD. Hypothyroidism as a mimic of liver failure in a patient with cirrhosis[J]. Ann Intern Med, 2007, 146(4): 315-316. DOI: 10.7326/0003-4819-146-4-200702200-00021.
[40]	HASSAN MM, KASEB A, LI D, et al. Association between hypothyroidism and hepatocellular carcinoma: A case-control study in the United States[J]. Hepatology, 2009, 49(5): 1563-1570. DOI: 10.1002/hep.22793.
[41]	REDDY A, DASH C, LEERAPUN A, et al. Hypothyroidism: A possible risk factor for liver cancer in patients with no known underlying cause of liver disease[J]. Clin Gastroenterol Hepatol, 2007, 5(1): 118-123. DOI: 10.1016/j.cgh.2006.07.011.
[42]	LIU YC, YEH CT, LIN KH. Molecular functions of thyroid hormone signaling in regulation of cancer progression and anti-apoptosis[J]. Int J Mol Sci, 2019, 20(20): 4986. DOI: 10.3390/ijms20204986.
[43]	GIONFRA F, DE VITO P, PALLOTTINI V, et al. The role of thyroid hormones in hepatocyte proliferation and liver cancer[J]. Front Endocrinol (Lausanne), 2019, 10: 532. DOI: 10.3389/fendo.2019.00532.
[44]	SAHIN T, ORAL A, TURKER F, et al. Can hypothyroidism be a protective factor for hepatocellular carcinoma in cirrhosis?[J]. Medicine (Baltimore), 2020, 99(11): e19492. DOI: 10.1097/MD.0000000000019492.
[45]	AGIASOTELLI D, ALEXOPOULOU A, VASILIEVA L, et al. Low free T3 levels are related to early mortality in patients with decompensated cirrhosis and acute-on chronic liver failure[J]. J Hepatol, 2014, 61(6): 1446-1447. DOI: 10.1016/j.jhep.2014.06.042.
[46]	FENG HL, LI Q, CAO WK, et al. Changes in thyroid function in patients with liver failure and their clinical significance: A clinical study of non-thyroidal illness syndrome in patients with liver failure[J]. Hepatobiliary Pancreat Dis Int, 2020, 19(6): 561-566. DOI: 10.1016/j.hbpd.2020.05.001.