📖Abnormal Liver Blood Tests in Patients with Hyperthyroidism: Systematic Review and Meta-Analysis

Abstract  抽象

Background: Abnormal liver blood tests (LBTs) in hyperthyroid patients are not uncommonly encountered. One major adverse event of antithyroid drug (ATD) therapy is drug-induced hepatotoxicity. Abnormal LBT in the hyperthyroidism scenario is a main diagnostic and therapeutic dilemma. We aimed to assess the prevalence and the response to ATD therapy of LBT abnormalities in newly diagnosed and uncomplicated hyperthyroidism through a systematic review and meta-analysis.
背景： 甲状腺功能亢进患者的肝脏血液检查 （LBT） 异常并不少见。抗甲状腺药物 （ATD） 治疗的一个主要不良事件是药物诱导的肝毒性。甲状腺功能亢进症情况下的 LBT 异常是一个主要的诊断和治疗困境。我们旨在通过系统评价和荟萃分析来评估新诊断和无并发症甲状腺功能亢进症中 LBT 异常的患病率和对 ATD 治疗的反应。

Methods: A literature search was performed reporting LBTs at presentation and after ATD therapy in hyperthyroid patients. A proportion meta-analysis was performed with random-effects model. Pooled data were presented with 95% confidence intervals (CI). I² statistic index was used to quantify the heterogeneity. Sensitivity analyses for prevalence of hyperthyroid patients with at least one abnormal LBT were performed. p-Value of <0.05 was regarded as significant.
方法： 进行文献检索，报告甲状腺功能亢进患者就诊时和 ATD 治疗后的 LBT。使用随机效应模型进行比例荟萃分析。合并数据以 95% 置信区间 （CI） 表示。采用 I² 统计指数量化异质性。对至少一种异常 LBT 的甲状腺功能亢进患者患病率进行了敏感性分析。%3C0.05 的 p 值被认为是显著的。

Results: The literature search yielded 2286 studies, of which 25 were included for systematic review and meta-analysis. The prevalence of untreated hyperthyroid and Graves' disease patients with at least one abnormal LBT was 55% ([CI 46–63%], I² 96%) and 60% ([CI 53–67%], I² 92%), respectively. The prevalence of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin (BIL), and γ-glutamyltransferase (GGT) abnormalities in hyperthyroid patients were 33% ([CI 24–44%], I² 95%), 23% ([CI 17–29%], I² 89%), 44% ([CI 35–52%], I² 93%), 12% ([CI 7–20%], I² 92%), and 24% ([CI 16–36%], I² 95%), respectively. ATD therapy, along with euthyroidism restoration, was accompanied by normalization of LBT abnormalities in the following percentage of cases: ALT 83% ([CI 72–90%], I² 46%), AST 87% ([CI 74–94%], I² 2%), ALP 53% ([CI 32–73%], I² 76%), BIL 50% (CI cannot be calculated), and GGT 70% ([CI 47–87%], I² 74%). The sensitivity analyses showed similar results as those of the main analyses. The publication bias was not statistically significant for all outcomes, except for the prevalence of resolved BIL abnormalities that was not calculable.
结果： 文献检索产生了 2286 项研究，其中 25 项被纳入系统评价和荟萃分析。未经治疗的甲状腺功能亢进症和格雷夫斯病患者至少有一个异常 LBT 的患病率分别为 55% （[CI 46-63%]， I² 96%） 和 60% （[CI 53-67%]， I² 92%）。甲状腺功能亢进患者丙氨酸转氨酶 （ALT）、天冬氨酸转氨酶 （AST）、碱性磷酸酶 （ALP）、总胆红素 （BIL） 和 γ-谷氨酰转移酶 （GGT） 异常的患病率为 33% （[CI 24-44%]， I² 95%）、23% （[CI 17-29%]， I² 89%）、44% （[CI 35-52%]， I² 93%）、12% （[CI 7-20%]， I² 92%） 和 24% （[CI 16-36%]， I² 95%）。ATD 治疗以及甲状腺功能正常的恢复伴随着以下百分比病例的 LBT 异常正常化：ALT 83% （[CI 72–90%]， I² 46%）， AST 87% （[CI 74–94%]， I² 2%）， ALP 53% （[CI 32–73%]， I² 76%）， BIL 50% （CI 无法计算） 和 GGT 70% （[CI 47–87%]， I² 74%）。敏感性分析显示的结果与主要分析的结果相似。除了无法计算的已解决的 BIL 异常的患病率外，所有结局的发表偏倚均无统计学意义。

Conclusions: LBT abnormalities are common in newly diagnosed and untreated hyperthyroidism setting. A high chance of safely normalizing elevated transaminases, up to fivefold above the upper limit of normal, accompanies the use of ATDs in the treatment of hyperthyroidism.
结论：LBT 异常在新诊断和未经治疗的甲状腺功能亢进症中很常见。使用 ATD 治疗甲状腺功能亢进症时，高出正常上限的转氨酶安全正常化的机会很高，最高可达正常上限的五倍。