慢性肾功能衰竭患者筛查甲状腺素结果分析
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摘要
目的通过慢性肾功能衰竭患者(chronic renal failure,CRF)筛查甲状腺素结果分析,了解慢性肾功能衰竭患者甲状腺素水平在不同时期的变化。方法根据甲状腺功能测定结果,住院CRF患者135例,按慢性肾功能衰竭分期:代偿期69例,失代偿期20例,肾衰竭期11例,尿毒症期35例。选取同一时期健康体检人群共95名为对照组。采用免疫放射法(IRMA)检测血清促甲状腺素(TSH);游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT_4)检测使用放射免疫法(RIA);同时用电化学发光法(ECLIA)检测抗甲状腺过氧化物酶抗体(TPOAB)和甲状腺球蛋白抗体(TGAB)。结果 CRF组的FT_3、FT_4和TT_3、TT_4显著低于对照组(P<0.01),TSH、TGAB和TPOAB显著高于对照组(P<0.01)。肾功能失代偿期的患者与其他三组比较,血清甲状腺激素水平FT_3、FT_4和TT_3、TT_4最低,而血清TSH、TPOAB和TRAB较其他三组则显著升高。结论血清甲状腺素水平降低与肾功能损害程度密切相关,血清甲状腺素异常变化往往发生在肾功能失代偿期阶段。因此,血清甲状腺素水平的监测对CRF患者具有一定的临床价值,在治疗过程中应予以适当关注。
Objective Thyroid Hormone(TH)could be affected by renal function.This study was conducted to evaluate the TH levels during different disease stages in chronic kidney disease(CKD)patients and analyze the effect of renal function on the TH.Methods 135 hospitalized patients with CKD between Jan,2015 and Dec,2015 were divided into four groups according to the serum creatinine and eGFR.Serum thyroid stimulating hormone(TSH),free triiodothyronine(FT_3),free thyroxine(FT_4)and total triiodothyronine(TT3)were measured by immunoradiometric assay(IRMA).The radioimmunoassay(RIA)was used for the detection of total thyroxine(TT_4).Meanwhile,anti-thyroid peroxidase antibodies(TPOAB)and thyroglobulin antibodies(TGAB)were detected by electrochemiluminescence(ECLIA).Results FT_3,FT_4 and TT3,TT4 levels in the CKD group were significantly lower than that in the control group(P<0.01),while TSH,TGAB and TPOAB were significantly higher than that in the control group(P<0.01).The values of serum FT_3,FT_4,TT_3 and TT_4 from patients in the decompensated group were the lowest,while serum TSH,TPOAB and TRAB increased more significantly,compared with those results of CKD patients in the other three groups.Conclusion The decreased serum TH level is closely related to the degree of renal dysfunction.The abnormal change of serum TH level usually occurs in the decompensated stage of renal function.Therefore,monitoring serum TH level has important clinical significance for CKD patients and it should be paid attention during the treatment.
Objective Thyroid Hormone(TH)could be affected by renal function.This study was conducted to evaluate the TH levels during different disease stages in chronic kidney disease(CKD)patients and analyze the effect of renal function on the TH.Methods 135 hospitalized patients with CKD between Jan,2015 and Dec,2015 were divided into four groups according to the serum creatinine and eGFR.Serum thyroid stimulating hormone(TSH),free triiodothyronine(FT_3),free thyroxine(FT_4)and total triiodothyronine(TT3)were measured by immunoradiometric assay(IRMA).The radioimmunoassay(RIA)was used for the detection of total thyroxine(TT_4).Meanwhile,anti-thyroid peroxidase antibodies(TPOAB)and thyroglobulin antibodies(TGAB)were detected by electrochemiluminescence(ECLIA).Results FT_3,FT_4 and TT3,TT4 levels in the CKD group were significantly lower than that in the control group(P<0.01),while TSH,TGAB and TPOAB were significantly higher than that in the control group(P<0.01).The values of serum FT_3,FT_4,TT_3 and TT_4 from patients in the decompensated group were the lowest,while serum TSH,TPOAB and TRAB increased more significantly,compared with those results of CKD patients in the other three groups.Conclusion The decreased serum TH level is closely related to the degree of renal dysfunction.The abnormal change of serum TH level usually occurs in the decompensated stage of renal function.Therefore,monitoring serum TH level has important clinical significance for CKD patients and it should be paid attention during the treatment.
引文
[1]陈灏珠.实用内科学[M].第11版.北京:人民卫生出版杜,2001:1929-1930.
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[9]RHEE C M,KALANTAR-ZADEH K,STREJA E,et al.The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease[J].Nephrol Dial Transplant,2015,30(2):282-287.
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[11]RAJEEV G,CHICKBALLAPUR RAYAPPA W D,VIJAYALAKSHMI R,et al.Evaluation of thyroid hormone levels in chronic kidney disease patients[J].Saudi J Kidney Dis Transpl,2015,26(1):90-93.
[12]CHONCHOL M,LIPPI G,SALVAGNO G,et al.Prevalence of subclinical hypothyroidism in patients with chronic kidney disease[J].Clin J Am Soc Nephrol,2008,3(5):1296-1300.
[13]AMATO A A,SANTOS G M,NEVES FDE A.Thyroid hormone action in chronic kidney disease[J].Curr Opin Endocrinol DiabetesObes,2008,15(5):459-465.
[14]OERTEL M,GROSS M,ROKOS H,et al.Selenium-dependent regulation of type I 5'-deiodinase expression[J].Am J Clin Nutr,1993,57(2 Suppl):313S-314S.
[15]MOHAMEDALI M,REDDY MADDIKA S,VYAS A,et al.Thyroid disorders and chronic kidney disease[J].Int J Nephrol,2014,2014:520281.
[16]SCHULTHEISS U T,DAYA N,GRAMS M E,et al.Thyroid function,reduced kidney function and incident chronic kidney disease in a community-based population:the Atherosclerosis Risk in Communities study[J].Nephrol Dial Transplant,2017,32(11):1874-1881.
[17]MEUWESE C L,GUSSEKLOO J,de CRAEN A J,et al.Thyroid status and renal function in older persons in the general population[J].J Clin Endocrinol Metab,2014,99(8):2689-2696.
[18]LaCAVA A,FANG C J,SINGH R P,et al.Manipulation of immune regulation in systemic lupus erythematosus[J].Autoimmun Rev,2005,4(8):515-519.
[19]张红卫,蒋明,黄伟英,等;系统性红斑狼疮患者甲状腺功能异常[J].广东医学,2001,22(1):58-59.
[20]MADER R,MISHAIL S,ADAWI M,et al.Thyroid dysfunction in patients with systemic lupus erythematosus(SLE):relation to disesase activity[J].Clin Rheumatol,2007,26(11):1891-1894.
[2]孙龙安,李龙,林钢.医学特种检验与实验室诊断[M].北京:人民军医出版社,2002:11-13.
[3]王质刚.血液净化学[M].第2版.北京:科学技术出版社,2003:422-465.
[4]OEAEL M,GROSS M,ROKOS H,et al.Selenium dependentregulation of type I 5'-deiodinase expression[J].Am J Clin Nutr,1993,57(2 Suppl):S313-314.
[5]陈家伦.内科疾病中血甲状腺激素及淋巴细胞T3受体的变化[J].中华内科杂志,1987,26(8):499.
[6]陈灏珠.实用内科学[M].第10版.北京:人民卫生出版社,1997:1028.
[7]GOLOMBEK S G.Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients[J].Semin Perinato,2008,32(6):413-418.
[8]XU G,YAN W,LI J.An update for the controversies and hypotheses of regulating nonthyroidal illness syndrome in chronic kidney diseases[J].Clin Exp Nephrol,2014,18(6):837-843.
[9]RHEE C M,KALANTAR-ZADEH K,STREJA E,et al.The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease[J].Nephrol Dial Transplant,2015,30(2):282-287.
[10]AFSAR B,YILMAZ M I,SIRIOPOL D,et al.Thyroid function and cardiovascular events in chronic kidney disease patients[J].J Nephrol,2017,30(2):235-242.
[11]RAJEEV G,CHICKBALLAPUR RAYAPPA W D,VIJAYALAKSHMI R,et al.Evaluation of thyroid hormone levels in chronic kidney disease patients[J].Saudi J Kidney Dis Transpl,2015,26(1):90-93.
[12]CHONCHOL M,LIPPI G,SALVAGNO G,et al.Prevalence of subclinical hypothyroidism in patients with chronic kidney disease[J].Clin J Am Soc Nephrol,2008,3(5):1296-1300.
[13]AMATO A A,SANTOS G M,NEVES FDE A.Thyroid hormone action in chronic kidney disease[J].Curr Opin Endocrinol DiabetesObes,2008,15(5):459-465.
[14]OERTEL M,GROSS M,ROKOS H,et al.Selenium-dependent regulation of type I 5'-deiodinase expression[J].Am J Clin Nutr,1993,57(2 Suppl):313S-314S.
[15]MOHAMEDALI M,REDDY MADDIKA S,VYAS A,et al.Thyroid disorders and chronic kidney disease[J].Int J Nephrol,2014,2014:520281.
[16]SCHULTHEISS U T,DAYA N,GRAMS M E,et al.Thyroid function,reduced kidney function and incident chronic kidney disease in a community-based population:the Atherosclerosis Risk in Communities study[J].Nephrol Dial Transplant,2017,32(11):1874-1881.
[17]MEUWESE C L,GUSSEKLOO J,de CRAEN A J,et al.Thyroid status and renal function in older persons in the general population[J].J Clin Endocrinol Metab,2014,99(8):2689-2696.
[18]LaCAVA A,FANG C J,SINGH R P,et al.Manipulation of immune regulation in systemic lupus erythematosus[J].Autoimmun Rev,2005,4(8):515-519.
[19]张红卫,蒋明,黄伟英,等;系统性红斑狼疮患者甲状腺功能异常[J].广东医学,2001,22(1):58-59.
[20]MADER R,MISHAIL S,ADAWI M,et al.Thyroid dysfunction in patients with systemic lupus erythematosus(SLE):relation to disesase activity[J].Clin Rheumatol,2007,26(11):1891-1894.