小儿原发性肾病综合征与血清甲状腺激素水平关系的临床研究

Clinical study of relationship between pediatric patients with PNS and blood levels of thyroid hormones

目的探讨原发性肾病综合征(PNS)与血清甲状腺激素(TH)水平的关系。方法收集2009年5月至2009年12月在郑州市儿童医院肾病风湿科住院确诊为PNS(初治)患儿65例为观察对象,检测血生化、皮质醇、甲状腺功能等。将TH水平低组进行随机分组,对照组30例,实验组24例,于尿蛋白转阴后复测相关指标,观察两组疗效有无差异。结果①65例原发初治的NS患儿中59例伴TH水平低下,占90.8%;6例正常,占9.2%。②治疗后实验组各检测指标:FT3、FT4、TT3、TT4与对照组相比,差异均具有显著性(P<0.05)。③PNS患儿血清FT3、FT4、TT3、TT4与血浆白蛋白成正相关,而TSH与血浆白蛋白无相关性。④两组疗效(病情缓解的时间、对激素治疗的反应、治疗后两组血浆白蛋白及胆固醇恢复情况)的比较其差异均无显著性(P>0.05)。结论①PNS患儿存在TH水平的低下,但无临床表现。②PNS患儿存在TH水平的低下,与肾病时血浆白蛋白漏出密切相关。③对于存在TH水平低下的患儿,不建议常规予TH替代治疗,若达到甲状腺功能减退症水平,建议予TH替代治疗。

Objective To study the relationship between primary nephrotic syndrom（PNS） and serum levels of thyroid hormones in children.Methods From May 2009 to December 2009,65 patients with PNS in Nephropathy Rheumatology of Zheng zhou Children＇s Hospital were collected in the study.To check blood biochemistry,cortisol,thyroid function etc.The children with low levels of serum thyroid hormones as the study group,and randomized them,one as control group,30 cases;Other as treatment group,24 cases.When urine protein is negative,to check blood biochemistry and thyroid function again,observing whether the effects is different between the two groups.Results ① The serum levels of thyroid hormones in children with PNS：there are 59 cases with low levels of thyroid hormones in the 65 cases,the percentage is 90.8%,and 6 cases is normal,the percentage is 9.2%.②The comparison of changes in thyroid hormone levels between before treatment and after treatment of the two groups：the results showed that the difference has clinical significance.③The relationship between the levels of serum thyroid hormones and plasma albumin：the indicators of thyroid function（FT3,FT4,TT3,TT4） in the children with PNS was positively correlated with the plasma albumin by the correlation analysis.TSH has no correlation with plasma albumin.④Comparison of efficacy between the two groups：the comparison of the remission times of the two groups was no significant difference（P0.05）.Conclutions ①There is low levels of thyroid hormones in the children with PNS,but without clinical manifestations.②The low levels of thyroid hormones in the children with PNS is closely related to the leakage of plasma albumin with kidney disease.③ For the children with low levels of thyroid hormones is not recommended for the routine replacement therapy of TH,it will recovery with the remission of primary disease.But for the one that significant decrease in thyroid hormones was recommended for TH replacement treatment.