15例肾病患儿甲状腺功能的测定

STUDY OF THYROID FUNCTION IN CHILDREN RENAL DISEASE

目的：探讨儿童肾病综合征（ＮＳ）和慢性肾衰竭（ＣＲＦ）导致甲状腺功能异常改变的机理，及在血浆蛋白异常改变时采用游离三碘甲状腺原氨酸（ＦＴ３）、游离甲状腺素（ＦＴ４）和促甲状腺素（ＴＳＨ）测定法评价甲状腺功能。方法：采用酶学免疫测定法检测了１５例肾脏疾病患儿的血清ＦＴ３、ＦＴ４和ＴＳＨ。其中８例为ＮＳ，７例为ＣＲＦ。并与７例ＮＳ恢复期（ＲＥＮＳ）患儿及９例正常儿童（ＮＣ）为对照。结果：与ＲＥＮＳ和ＮＣ对照组相比，ＮＳ组的ＦＴ４降低、ＴＳＨ升高（均Ｐ＜００５）。ＣＲＦ组ＦＴ４和ＦＴ３均明显降低（Ｐ＜００５），而ＴＳＨ无明显改变（Ｐ＞００５）。ＲＥＮＳ的各项指标与ＮＣ无差异（Ｐ＞００５）。ＮＳ和ＣＲＦ的血清ＦＴ３、ＦＴ４和ＴＳＨ的改变与血清蛋白、尿蛋白均无相关关系。结论：ＮＳ和ＣＲＦ急性期患儿都存在着甲状腺功能指标异常降低，ＮＳ恢复期甲状腺功能可恢复正常，提示无需甲状腺激素治疗；而ＣＲＦ可导致中枢性的甲状腺功能障碍，甲状腺激素治疗有一定价值。

Objective:To investigate the changes of thyroid hormore(TH) abnormalities in nephrotic syndrome(NS) and chronic renal failure(CRF),the serum free tri iodothyronine(FT 3) and thyroxine(FT 4) levels were used to estimate the thyroid function when there is some alteration in serum binding protein of NS and CRF.Methods:We have examined the serum FT 3,FT 4 and TSH of children NS( n =8) and CRF( n =7),in comparison with that of two control groups,in remission of NS(RENS=7) and age matched children(NC=9).Results:In Comparison with two control groups,a significant decrease in FT 4( P <0 05) and increase in the serum TSH concentration( P <0 05) in NS were observed.The serum FT 3 and FT 4( P <0 05) concentration were significantly decreased,but the serum TSH was normal( P >0 05) in CRF.The serum FT 3,FT 4 and TSH of RENS was no significantly different from those of NC.We found that there was no relationship of the serum albumin or urinary protein with the serum FT 3,FT 4,TSH in NS and CRF.Conclusion:Even though these thyroid function were impaired in NS and CRF,the pathogenesis may be different in some degree.This kind of hypothyroidism in CRF may be due to a deficiency of TSH secretion from the pituitary.Thyroid hormone normalized in NS remission may not suggested that it is necessary.