关键词: 三碘甲状腺原氨酸, 反三碘甲状腺原氨酸, 甲状腺素, 晚期血吸虫病, 肝硬化

Abstract: Objective　To observe the changes of serum triiodothyronine (T3), thyroxine (T4), reverse T3 （rT3） and the ratios of T3/rT3 and T4/rT3 in advanced schistosomiasis patients, and evaluate the prognostic values.   Methods　According to the ratios of urinary sodium， 138 patients with advanced schistosomiasis were classified into minor grade （35 mmol/d, 85 cases）， moderate grade （1030 mmol/d, 27 cases） and severe grade （＜10 mmol/d, 26 cases）. By radioimmunoassay， the levels of T3， T4 and rT3 in advanced schistosomiasis patients were measured before and after therapy， and the results were compared with those of 30 healthy controls. The T3/rT3 ratio and T4/rT3 ratio were also calculated. Hepatic function indices ［total bilirubin（TBil）， total protein（TP）， albumin（Alb）and alanine aminotransferase（ALT）］ were detected simultaneously. The relationship of the correlation and prognosis of compensatory mechanism was analyzed.  Results　The levels of T3 and T4 in the minor grade group were lower than those in healthy controls（P<0.05）， and the levels of T3 and T4 in the moderate grade and severe grade groups decreased sharply（P<0.01,P<0.001）. The level of rT3 in patients with advanced schistosomiasis was higher than that in the healthy controls， and the levels of rT3 in moderate grade and severe grade groups increased significantly （P<0.001）. The ratios of T3/rT3 and T4/rT3 increased gradually with the severity of grade（minor grade， moderate grade and severe grade, P<0.01,P<0.001). The ratios of T3/rT3 and T4/rT3 in 26 severe grade patients with refractory ascites were lower than those with uncomplicated ascites（P<0.001）. When discharging from the hospital， the ratios of T3/rT3 and T4/rT3 in patients with uncomplicated ascites increased significantly（P<0.05）， while those with refractory ascites had a downward tendency， indicating the poor prognosis. The ratios of T3/rT3 and T4/rT3 in 26 severe grade patients were dynamically monitored， including 19 cured patients gradually recovering with time， 4 patients showing a decrease trend with the progression of the disease， and 3 cases of deaths going down and reaching the minimum value （0.10±0.05）. Conclusions　The ratios of T3/rT3 and T4/rT3 in advanced schistosomiasis patients are sensitive indicators for liver function lesion， especially for monitoring the prognosis dynamically in patients with advanced schistosomiasis. 

Key words: Triiodothyronine, Reverse triiodothyronine, Thyroxine;Advanced schistosomiasis, Cirrhosis