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간경변증 환자의 중증도 판단지표로서의 갑상선 호르몬 측정
양건호,윤종만,박일종,박해옥,최성규,김석빈 대한내과학회 1986 대한내과학회지 Vol.31 No.3
Liver is one of the major sites of thyroxine(T4) metabolism. This study examined the influence of degree of hepatocellular damage on thyroid hormone concentrations in cirrhotic patients. The concentrations of triiodothyronine(T3), thyroxine (T4), free thyroxine(free T4) and T3/T4 ratio were investigated in 32 cirrhotic patients and 20 controls. Cirrhotic patients were divided into several groups according to the severity of hepatic cirrhosis as defined by Composite Clinical and Laboratory Index(CCLI). The results were as follows: 1) Serum T4 was reduced in group 1 with CCLl $gt;20. However, no significant correlation was observed between T4 and CCLI or any of the liver function tests. 2) Serum T3 declined as CCLI increased. A significant negative correlation was observed between two parameters(p$lt;0.01). Furthermore, if liver function tests were individually examined, serum T3 demonstrated significant negative correlations with serum bilirubin and prothrombin time(sec) (p$lt;.0.05, p$lt;.0,05). 3) The fall in serum T3 may be secondary to reduced synthesis of T3 from T4 as reflected by decreased T3/T4 ratio. 4) Moreover, T3 synthesis from T4 appeared to be dependent on severity of hepatocellular damage as demonstrated by a significant negative correlation between CCLI and T3/T4 ratio(p$lt;0.01). These results suggest that T3/T4 ratio represents the severity of hepatocellular damage in liver cirrhosis.
급성 간내담즙정체성 황달 환자의 혈청 γ-Glutamyl transpeptidase 활성도에 관한 연구
남광우,양건호,윤종만,박일종,김석빈 대한내과학회 1986 대한내과학회지 Vol.31 No.2
The serum γ-GTP activity was measured by modified Orlowski`s method in 23 patients with acute intrahepatic cholestasis(13 cases of acute hepatitis, 7 cases of acute cholestatic hepatitis, and 3 cases of acute fulminant hepatitis) and 26 patients with extrahepatic cholestasis(7 cases of pancreatic head cancer, 2 cases of ampulla of Vater cancer, 6 cases of CBD malignancy, 7 cases of CBD stone, p cases of CBD ascaris, 1 case of clornochiasis and 1 case of sclerosing cholangitis). Forty persons with no liver problem servedas a control group. The results were as follows; 1) The mean value of serum γ-GTP in the control group was 36.13±11.83 U/L, and there was no significant difference between the two sexes. 2) In cases of acute intrahepatic cholestasis, serum γ-GTP activity was relatively low(acute cholestatic hepatitis 57,00±20.66 U/L and fulminant hepatitis 36.67±13.89 U/L) in spite of a marked increase in serum bilirubin concentration and alkaline phosphatase activity. 3) In cases of extrahepatic cholestasis, serum γ-GTP showed increased activity with mean value of 451.19±245.77 U/L together with elevation of serum bilirubin and alkaline phosphatase levels. 4) The ratio of γ-GTP to serum alkaline phosphatase in cases of acute intrahepatic cholestasis was markedly decreased as compared to that in cases of extrahepatic cholestasis(p$lt;0.001). This finding suggests that low γ-GTP activity is useful in the differentiation of acute intrahepatic cholestasis from extrahepatic cholestasis.