Multidisciplinary expert consensus on diagnosis and treatment of hyperthyroidism with abnormal liver function
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摘要: 甲状腺功能亢进症(甲亢)伴肝功能异常是临床诊断和治疗中的一个难题,其主要包括甲亢相关肝损伤、抗甲状腺药物(ATD)所致肝损伤和甲亢合并其他肝脏疾病。中国药理学会药源性疾病学专业委员会、中国毒理学会临床毒理学专业委员会和《药物不良反应杂志》编辑委员会组织内分泌学、肝脏病学和临床药学领域的相关专家共同研讨,在系统梳理国内外相关研究进展的基础上,结合我国的临床实际情况,制订了本共识。本共识系统阐述了甲亢伴肝功能异常的流行病学、发生机制、临床特征、诊断与鉴别诊断、监测和治疗,提出了诊断和治疗的推荐意见,旨在帮助临床医师在甲亢伴肝功能异常的预防、诊断和治疗实践中做出合理决策,提高临床诊治水平。Abstract: Hyperthyroidism combined with abnormal liver function is a tricky problem in clinical diagnosis and treatment, which mainly includes hyperthyroidism⁃related liver injury, liver injury caused by antithyroid drugs (ATD), and other liver diseases associated with hyperthyroidism. Chinese Pharmacological Society Professional Committee of Drug⁃induced Diseases, Section of Clinical Toxicology of Chinese Society of Toxicology, and the Editorial Committee of Adverse Drug Reactions Journal organized relevant experts majoring in endocrinology, hepatology, and clinical pharmacy to jointly discuss and formulate this consensus based on a systematic review of relevant research progress at home and abroad, combined with the actual clinical situation in China. This consensus systematically expounds the epidemiology, pathogenesis, clinical characteristics, diagnosis and differential diagnosis, monitoring and treatment of hyperthyroidism with liver dysfunction, and puts forward recommendations for diagnosis and treatment, aiming to help clinicians make reasonable decisions in the prevention, diagnosis and treatment of hyperthyroidism combined with abnormal liver function, and improve the level of clinical diagnosis and treatment.
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表 1 GRADE系统的推荐强度
Table 1. Recommended strength level of GRADE system
推荐强度 具体描述 强推荐(1级) 明确显示干预措施利大于弊或弊大于利 弱推荐(2级) 利弊不确定或无论质量高低的证据均显示利弊相当 注:GRADE,证据推荐分级的评估、制定与评价。
表 2 GRADE系统的证据质量分级
Table 2. Levels of evidence quality in GRADE system
证据级别 定义 高质量(A) 非常确信估计的效应值接近真实的效应值,进一步研究也不可能改变该估计效应值的可信度 中等质量(B) 对估计的效应值确信程度中等,估计值有可能接近真实值,但仍存在二者不相同的可能性,进一步研究有可能
改变该估计效应值的可信度低质量(C) 对估计的效应值确信程度有限,估计值与真实值可能大不相同,进一步研究极有可能改变该估计效应值的可
信度极低质量(D) 对估计的效应值几乎没有信心,估计值与真实值很可能完全不同;对效应值的任何估计都很不确定 注:GRADE,证据推荐分级的评估、制定与评价。
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甲状腺功能亢进症伴肝功能异常诊断和治疗多学科专家共识(2025年)-参考文献.pdf
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