慢性肾脏病非透析患者血游离三碘甲腺原氨酸对左心室肥厚的影响

Effect of serum free triiodothyronine on left ventricular hypertrophy in predialysis patients with chronic kidney disease

目的:探讨慢性肾脏病非透析患者血游离三碘甲腺原氨酸(FT_3)对左心室肥厚(LVH)的影响。方法:回顾性地分析2006年11月至2009年3月在本院肾内科住院治疗的43例慢性肾脏病非透析患者的临床资料。根据左心室质量指数(LVMI)将患者分为两组,即LVH组(24例)和非LVH组(19例),比较两组血甲状腺激素谱及其他指标的不同,并采用多元线性回归模型探讨血FT_3对LVMI的独立影响作用。结果:与非LVH组相比,LVH组患者估计肾小球滤过率[eGFR,(10.2±10.0)mL/(min·1.73 m^2)vs 20.8±14.5 mL/(min·1.73 m^2),P<0.05]、血红蛋白[HGB,(71.8±17.6)g/L vs 102±25.3 g/L,P<0.001和血白蛋白[ALB,(32.8±4.9)g/L vs(37.1±5.8)g/L,P<0.05]更低,而血磷水平[(1.98±0.62)mmol/L vs(1.28±0.31)mmol/L,P<0.001]则更高。同时LVH患者还呈现更低的血FT_3水平[(2.34±0.83)pmol/Lvs(3.17±0.68)pmol/L,P<0.05]和更高的低T3综合征发生率(50%vs 14.3%,P<0.05)。多因素分析显示血FT_3和血磷能独立地影响LVMI的水平(R^2=0.650,P<0.001)。结论:慢性肾脏病非透析患者存在较高的低T_3综合征和LVH发生率,并且低的血FT_3对于LVH具有独立的影响作用。

Objective： To examine the effect of serum free triiodothyronine （FT3 ） on left ventricular hypertrophy （LVtt） in predialysis patients with chronic kidney disease （CKD）. Methods： A retrospective study was performed to analyze the 43 predialysis patients with CKD who had been hospitalized in our division from November, 2006 to March, 2009. According to the left ventricular mass index （LVMI）, all patients were divided into a LVH group （24 cases） and a non-LVH group （19 cases） to compare the differences in serum thyroid hormones and other variables. Multivariate analysis was used to examine the independent effect of serum FT3 on LVMI in this group. Results：The LVH group demonstrated significantly lower levels than the non-LVH group in estimated glomerular filtration rate[ eGFR, （ 10.2 ± 10.0） mL/（ min ± 1.73 m2 ） vs 20.8 ± 14.5 mL/ （min· 1.73 m^2^）, P〈O.05], hemoglobin[HGB, （71.8 ±17.6）g/L vs （102 ±25.3） g/L, P〈0.001] and serum albumin [ ALB, （32.8 ± 4.9） g/L vs （37.1 ± 5.8） g/L, P 〈 0.05 ] but a significantly higher level in serum phosphate I （ 1.98 ± O. 62） mmol/L vs （ 1. 28 ± O. 31 ） mmol/L, P 〈 0. 001 1. Significantly higher prevalence of low T3 syndrome （50% vs 14. 3 % , P 〈 0.05 ） and lower serum FT3 （2.34 ± 0.83 vs 3.17 ±0.68 pmol/L, P 〈 0.05 ） were observed in patients with LVH than in those without LVH. After adjustments for gender, eGFR, HGB and serum ALB, the multivariate analysis showed that serum FT3 and phosphate had independent effects on the level of LVMI in this group （R2 = O. 650, P 〈 O. 001 ）. Conclusion： Predialysis patients with CKD may ilave high risks of LVH and low T3 syndrome, and a reduced level of serum FT3 may affect independently the development of LVH in this population.