维持性血液透析患者甲状腺功能异常的临床特点
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摘要
目的分析维持性血液透析(MHD)患者甲状腺功能异常的情况及其影响。方法选取MHD患者69例,分别检测游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH),根据参考值将甲状腺功能异常分为单纯低T3组、低T3合并低T4组、亚临床甲状腺功能减退组,分别比较其临床资料与正常组的差异。结果 MHD患者合并甲状腺功能异常的比例为58%。单纯低FT3组年龄大于60岁的患者比例(66.7%)明显高于正常组(33%)(P<0.05)。低T3合并低T4组患者的红细胞、血红蛋白、红细胞压块、钙磷乘积、白蛋白水平较正常组明显偏低(P<0.05),亚临床甲状腺功能减退的患者红细胞、胆固醇的水平与正常组存在显著差异(P<0.05)。甲状腺功能异常组与正常组在心脏结构和肺动脉压力方面无明显差异。结论维持性血液透析患者的甲状腺功能异常可能会影响预后,需要引起临床医生的关注。
Objective To investigate the abnormal thyroid functions and influencing factors in patients with maintenance hemodialysis(MHD).Methods Sixty-nine patients with MHD were selected,and free tri-iodothyronen(FT3),free thyronine(FT4)and thyroid-stimulating hormone(TSH)were determined.Thyroid disorders were classified into pure low FT3,low FT3 and low FT4,subclinical state groups.The clinical biochemical results were compared among different groups.Results The proportion of the thyroid dysfunction in patients with MHD was 58%.There were more patients,who were older than 60 years,in pure low FT3 group than in normal control group(P<0.05).The difference was statistically significant in red cells,hemoglobin,HCT,calcium-phosphorus pruduct and Alb between low FT3 and Low FT4 group and normal control group(P<0.05).There was also significant difference in red cells and cholesterol between subclinical state group and normal control group(P<0.05).However,there was no significant difference in cardiac structure and pulmonary hypertention between thyroid dysfunction groups and normal control group.Conclusions Clinicians should pay more attention to the thyroid dysfunction,which may influence the prognosis of patients with MHD.
Objective To investigate the abnormal thyroid functions and influencing factors in patients with maintenance hemodialysis(MHD).Methods Sixty-nine patients with MHD were selected,and free tri-iodothyronen(FT3),free thyronine(FT4)and thyroid-stimulating hormone(TSH)were determined.Thyroid disorders were classified into pure low FT3,low FT3 and low FT4,subclinical state groups.The clinical biochemical results were compared among different groups.Results The proportion of the thyroid dysfunction in patients with MHD was 58%.There were more patients,who were older than 60 years,in pure low FT3 group than in normal control group(P<0.05).The difference was statistically significant in red cells,hemoglobin,HCT,calcium-phosphorus pruduct and Alb between low FT3 and Low FT4 group and normal control group(P<0.05).There was also significant difference in red cells and cholesterol between subclinical state group and normal control group(P<0.05).However,there was no significant difference in cardiac structure and pulmonary hypertention between thyroid dysfunction groups and normal control group.Conclusions Clinicians should pay more attention to the thyroid dysfunction,which may influence the prognosis of patients with MHD.
引文
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[2]De Groot LJ.Dangerous dogmas in medicine:the nonthyroidal illness syndrome[J].J Clin Endocrinol Metab,1999,84(1):151-164.
[3]Zoccali C,Tripepi G,Cutrupi S,et al.Low triiodothyronine:A new facet of inflammation in end-stage renal disease[J].JAm Soc Nephrol,2005,16(9):2789-2795.
[4]赵璐杰,李超林.终末期肾脏病患者甲状腺功能的变化[J].中国血液净化,2012,11(8):436-438.
[5]翁光明.血液透析对慢性肾衰竭患者甲状腺激素水平的影响[J].中国老年学杂志,2012,32(23):5280-5281.
[6]Lu L,Zhang Q,Pu LJ,et al.Elevation of tumor necrosis factor-alpha,interleukin-1beta and interleukin-6 levels in aortic intima of Chinese Guizhou minipigs with streptozotocin-induced diabetes[J].Chin Med J(Engl),2007,120(6):479-484.
[7]董松,张熙洋,蒋秋明,等.维持性血液透析患者甲状腺功能异常的临床特征[J].山东医药,2014,54(37):33-35.
[8]Zoccali C,Mallamaci F,Tripepi G,et al.Low triiodothyronine and survival in end-stage renal disease[J].Kidney Int,2006,70(3):523-528.
[9]Ambrosius W,Kazmierski R,Gupta V,et al.Low free triiodothyronine levels are related to poor prognosis in acute ischemic stroke[J].Exp Clin Endocrinol Diabetes,2011,119(3):139-143.
[10]Ng YY,Lin HD,Wu SC,et al.Impact of thyroid dysfunction on erythropoietin dosage in hemodialysis patients[J].Thyroid,2013,23(5):552-561.
[11]Lee YK,Kim JE,Oh HJ,et al.Serum TSH level in healthy Koreans and the association of TSH with serum lipid concentration and metabolic syndrome[J].Korean J Intern Med,2011,26(4):432-439.
[12]何萍,毛慧娟.慢性肾脏病患者甲状腺功能与心血管疾病相关性的研究进展[J].临床肾脏病杂志,2015,15(7):443-446.
[2]De Groot LJ.Dangerous dogmas in medicine:the nonthyroidal illness syndrome[J].J Clin Endocrinol Metab,1999,84(1):151-164.
[3]Zoccali C,Tripepi G,Cutrupi S,et al.Low triiodothyronine:A new facet of inflammation in end-stage renal disease[J].JAm Soc Nephrol,2005,16(9):2789-2795.
[4]赵璐杰,李超林.终末期肾脏病患者甲状腺功能的变化[J].中国血液净化,2012,11(8):436-438.
[5]翁光明.血液透析对慢性肾衰竭患者甲状腺激素水平的影响[J].中国老年学杂志,2012,32(23):5280-5281.
[6]Lu L,Zhang Q,Pu LJ,et al.Elevation of tumor necrosis factor-alpha,interleukin-1beta and interleukin-6 levels in aortic intima of Chinese Guizhou minipigs with streptozotocin-induced diabetes[J].Chin Med J(Engl),2007,120(6):479-484.
[7]董松,张熙洋,蒋秋明,等.维持性血液透析患者甲状腺功能异常的临床特征[J].山东医药,2014,54(37):33-35.
[8]Zoccali C,Mallamaci F,Tripepi G,et al.Low triiodothyronine and survival in end-stage renal disease[J].Kidney Int,2006,70(3):523-528.
[9]Ambrosius W,Kazmierski R,Gupta V,et al.Low free triiodothyronine levels are related to poor prognosis in acute ischemic stroke[J].Exp Clin Endocrinol Diabetes,2011,119(3):139-143.
[10]Ng YY,Lin HD,Wu SC,et al.Impact of thyroid dysfunction on erythropoietin dosage in hemodialysis patients[J].Thyroid,2013,23(5):552-561.
[11]Lee YK,Kim JE,Oh HJ,et al.Serum TSH level in healthy Koreans and the association of TSH with serum lipid concentration and metabolic syndrome[J].Korean J Intern Med,2011,26(4):432-439.
[12]何萍,毛慧娟.慢性肾脏病患者甲状腺功能与心血管疾病相关性的研究进展[J].临床肾脏病杂志,2015,15(7):443-446.