原发性肾病综合征肾损害与甲状腺功能的相关性
摘要
目的探讨原发性肾病综合征(PNS)患者肾损害与甲状腺功能的相关性。方法根据24小时尿蛋白量将63例PNS患者分为活动期33例(活动组)和缓解期(缓解组)30例,并选择同期30例体检健康者作为对照组。测定三组肾功能指标[血清白蛋白、肌酐(Cr)、尿素氮(BUN)]及甲状腺功能指标[血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺激素(FT4)和促甲状腺激素(TSH)],比较各组甲状腺激素水平变化,并分析肾损害与甲状腺功能的相关性。结果与对照组比较,缓解组FT3明显降低,FT4、TSH水平无明显差异(P>0.05),与缓解组比较,活动组FT3、FT4水平显著降低,TSH水平、甲减或亚临床甲减的发生率均显著升高(P<0.05)。经Pearson相关性分析显示,缓解组FT3、FT4与UAER均呈显著负相关,而TSH与UAER呈显著正相关(P<0.05)。活动组FT3、FT4与血清白蛋白均呈显著正相关,与Cr、BUN、UAER呈负相关(P<0.05)。TSH与血清白蛋白均呈显著负相关,与Cr、BUN、UAER呈显著正相关(P<0.05)。结论 PNS患者存在不同程度甲状腺功能减退,甲状腺功能减退的发生、发展与肾损伤密切相关。
引文
[1] Khatiwada S,Rajendra KC,Gautam S,et al. Thyroid dysfunction and dyslipidemia in chronic kidney disease patients.Bmc Endocrine Disorders,2014,15(1):1
[2] Farwell AP. Nonthyroidal illness syndrome.Curr Opin Endocrinol Diabetes Obes,2013,20(5):478
[3]黄荣贵.肾病综合征与甲状腺功能关系的研究现状及进展.临床医药文献电子杂志,2017,4(73):14449,14452
[4]叶任高,陆再英.内科学.北京:人民卫生出版社,2004:725
[5]陈灏珠.实用内科学.10版.北京:人民卫生出版社,1998:1031
[6]滕卫平.亚临床甲状腺功能减退症.国外医学(内分泌学分册),2003,23(6):370
[7] Purkait R,Mukherji A. Congenital nephrotic syndrome with hypothyroidism:an unusual association. J Coll Physicians Surg Pak,2013,23(9):687
[8] Yeoh EC,Claude JR,Rajasoorya C.Paradox of rising thyroid stimulating hormone despite increasing thyroxine dose in hypothyroidism and the association with nephrotic syndrome.Nephrology(Carlton),2013,18(9):647
[9] Takakura M,Shimizu M,Inoue N,et al.Iodine-induced nonautoimmune hypothyroidism in a patient with steroid-resistant nephrotic syndrome. Pediatr Int,2015,57(5):1055
[10] Marimuthu V,Krishnamurthy S,Rajappa M.Non-Autoimmune Subclinical and Overt Hypothyroidism in Idiopathic Steroidresistant Nephrotic Syndrome in Children.Indian Pediatr,2017,54(11):925
[11] Mario FD,Pofi R,Gigante A,et al. Hypothyroidism and Nephrotic Syndrome:Why,When and How to Treat. Curr Vasc Pharmacol,2017,15(5):398
[12]肖伟平,牛丹,刊吉平,等.肾病综合征伴甲状腺激素水平异常患者临床病理分析.临床肾脏病杂志,2013,13(4):161
[13]赵静,田梅.慢性肾脏病和甲状腺功能相关性的研究进展.医药前沿,2017,7(29):6
[14] Wiersinga M. Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism. Nat Rev Endocrinol,2014,10(3):164
[15] Dousdampanis P,Trigka K,Vagenakis GA,et at.The thyroid and the kidney:a complex interplay in health and disease.Int J Artif Organs,2014,37(1):1
[16] Shin DH,Lee MJ,Lee HS,et a1.Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism.Thyroid,2013,23(6):654
[17] Toru S,Ken O,Tomoya K,et al.Importance of specific reference.values for evaluation of deteriorating thyroid function in patients with end-stage venal disease on hemoclialysis.Journal of Endocrinological Investigation,2015,38(1):47
[2] Farwell AP. Nonthyroidal illness syndrome.Curr Opin Endocrinol Diabetes Obes,2013,20(5):478
[3]黄荣贵.肾病综合征与甲状腺功能关系的研究现状及进展.临床医药文献电子杂志,2017,4(73):14449,14452
[4]叶任高,陆再英.内科学.北京:人民卫生出版社,2004:725
[5]陈灏珠.实用内科学.10版.北京:人民卫生出版社,1998:1031
[6]滕卫平.亚临床甲状腺功能减退症.国外医学(内分泌学分册),2003,23(6):370
[7] Purkait R,Mukherji A. Congenital nephrotic syndrome with hypothyroidism:an unusual association. J Coll Physicians Surg Pak,2013,23(9):687
[8] Yeoh EC,Claude JR,Rajasoorya C.Paradox of rising thyroid stimulating hormone despite increasing thyroxine dose in hypothyroidism and the association with nephrotic syndrome.Nephrology(Carlton),2013,18(9):647
[9] Takakura M,Shimizu M,Inoue N,et al.Iodine-induced nonautoimmune hypothyroidism in a patient with steroid-resistant nephrotic syndrome. Pediatr Int,2015,57(5):1055
[10] Marimuthu V,Krishnamurthy S,Rajappa M.Non-Autoimmune Subclinical and Overt Hypothyroidism in Idiopathic Steroidresistant Nephrotic Syndrome in Children.Indian Pediatr,2017,54(11):925
[11] Mario FD,Pofi R,Gigante A,et al. Hypothyroidism and Nephrotic Syndrome:Why,When and How to Treat. Curr Vasc Pharmacol,2017,15(5):398
[12]肖伟平,牛丹,刊吉平,等.肾病综合征伴甲状腺激素水平异常患者临床病理分析.临床肾脏病杂志,2013,13(4):161
[13]赵静,田梅.慢性肾脏病和甲状腺功能相关性的研究进展.医药前沿,2017,7(29):6
[14] Wiersinga M. Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism. Nat Rev Endocrinol,2014,10(3):164
[15] Dousdampanis P,Trigka K,Vagenakis GA,et at.The thyroid and the kidney:a complex interplay in health and disease.Int J Artif Organs,2014,37(1):1
[16] Shin DH,Lee MJ,Lee HS,et a1.Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism.Thyroid,2013,23(6):654
[17] Toru S,Ken O,Tomoya K,et al.Importance of specific reference.values for evaluation of deteriorating thyroid function in patients with end-stage venal disease on hemoclialysis.Journal of Endocrinological Investigation,2015,38(1):47