重度子痫前期合并甲状腺功能减退症孕妇的甲状腺激素水平变化与肾功能的相关性

Correlation between thyroid hormones and renal function in severe pre-eclampsia patients with hypothyroidism

目的 探讨重度子痫前期孕妇合并不同程度的甲状腺功能减退症（甲减）对肾功能指标的影响及与甲状腺激素水平的相关性.方法 选择2011年5月至2013年3月在中国医科大学附属盛京医院住院并分娩的46例重度子痫前期合并亚临床甲减（亚甲减）孕妇为亚甲减组,23例重度子痫前期合并临床甲减孕妇为甲减组,109例促甲状腺激素（TSH）水平正常的重度子痫前期孕妇为单纯子痫前期组.检测各组孕妇的甲状腺激素水平和肾功能指标,对各组孕妇肾功能指标异常检出率进行相对风险度分析;对甲状腺激素水平与血清尿酸、尿素及肌酐的相关性进行分析.结果 （1）亚甲减组孕妇TSH水平为（6.1±3.2） mU/L,游离三碘甲状腺原氨酸（FT3）水平为（4.0±0.6）pmol/L,游离甲状腺素（FT4）水平为（11.8±1.5） pmol/L;甲减组孕妇TSH水平为（5.2±1.3）mU/L,FT3水平为（3.7±0.6） pmol/L,FT4水平为（9.3±0.5） pmol/L;单纯子痫前期组孕妇TSH水平为（1.9±0.8） mU/L,FT3水平为（4.0±0.8）pmol/L,FT4水平为（11.9±1.9） pmol/L.亚甲减组孕妇TSH水平明显高于单纯子痫前期组（P＜0.01）;亚甲减组与甲减组比较,差异无统计学意义（P＞0.05）;3组孕妇FT3水平分别比较,差异均无统计学意义（P＞0.05）;甲减组孕妇FT4水平明显低于亚甲减组和单纯子痫前期组（P＜0.05）.（2）甲减组孕妇血清尿酸、肌酐及尿素水平分别为（436±114）、（75± 15） μmol/L及（6±3） mmol/L,单纯子痫前期组孕妇分别为（378±114）、（65±22） μmol/L及（5±3） mmol/L,两组分别比较,差异均有统计学意义（P＜0.05）;亚甲减组与甲减组比较,差异均无统计学意义（P＞0.05）.（3）亚甲减组孕妇尿酸水平异常检出率（46％,21/46）显著高于甲减组（22％,5/23;P＜0.05）.其余指标各组间分别比较,差异均无统计学意义（P＞0.05）.（4）亚甲减组孕妇血清FT3水平与血清尿素、血清肌酐及血清尿酸水平均呈负相关（r=-0.32、-0.58、-0.35,P＜0.05）;血清TSH和FT4水平与肾功能各项指标均无相关性（P＞0.05）.甲减组孕妇FT3水平与血清肌酐水平呈负相关（r=-0.40,P＜O.05）,与血清尿酸和尿素水平无相关性（P＞0.05）;单纯子痫前期组孕妇TSH水平与血清肌酐水平呈正相关性（r=0.20,P=0.04）,与血清尿素水平无相关性（r=0.04,P=0.65）,与血清尿酸水平无相关性（r=0.12,P=0.20）.结论 重度子痫前期孕妇合并甲减或亚甲减可影响肾功能,合并甲减孕妇的血清尿酸、尿素和肌酐水平均明显高于TSH水平正常的单纯重度子痫前期者;重度子痫前期合并甲减或亚甲减孕妇血清FT3水平与肌酐水平呈负相关.密切监测重度子痫前期孕妇的甲状腺功能,可及时发现肾功能损害并治疗甲减.

Objective To study effects of different degree of hypothyroidism in severe pre- eclampsia （S-PE） pregnant women on renal funetion and the eorrelation between them. Methods 46 S-PE patients with subclinical hypothyroidism （SCH） registered for treatment in the Shengjing Hospital of China Medical University from May 2011 to March 2013 were selected into SCH group, and 23 S-PE with overt hypothyroidism （OH） were selected into OH group,and 109 S-PE with normal thyroid stimulating hormone （TSH） levels were selected into simple group. Thyroid hormone and kidney function tests were analyzed in pregnant women with S-PE. We made an analysis of the relative risk of the detection rate of abnormal renal function and also the relationship between the levels of thyroid hormone and serum uric acid, serum urea and creatinine in patients with S-PE. Results （1） In SCH group serum TSH was （6.1＋3.2） mU/L, free triiodothyronine （FT3） was （4.0＋0.6） pmol/L, free thyroxine （FT4） was （11.8＋1.5） pmol/L; in OH group serum TSH was （5.2＋1.3） mU/L, FTz was （3.7_＋0.6） pmol/L, ETa was （9.3_＋0.5） pmol/L; in simple S-PE group serum TSH was （1.9_＋0.8） mU/L, FT3 was （4.0_＋0.8） pmol/L and FT4 was （11.9＋1.9） pmol/L. TSH in SCH group was significantly higher than that in simple S-PE group（P〉0.01 ）, the difference of in SCH and OH group were not statistically significant （P〉0.05）. The difference of FT3 in three groups were not statistically significant （1~〈0.05） ;FT4 in OH group was significantly lower than thoes in SCH and simple groups （P〈0.05）. （2）Serum uric acid, ereatinine and urea levels in OH group was （436 ＋ 114）, （75 ＋ 15） p^mol/L and （6-＋ 3 ）mmol/L, in simple S-PE group they were（378＋114）,（65＋22） ~xmol/L and（5＋3）mmol/L. In comparison, the differences was statistically significant（P〈0.05）. The differences were not statistically significant in SCH and OH groups （P〉0.05）. （3）The abnormal detection rate of uric acid was significantly higher in SCH than that in OH group [46% （21/46） versus 22% （5/23）, 0R=3.0, P〈0.05]. The comparison of remaining index has no statistical significance（P〉0.05）. （4）In SCtt group there was a significant inverse correlation of serum FT3 with serum urea levels, serum ereatinine and serum uric acid （r=- 0.32,-0.58,-0.35, P〈0.05）. There was not a correlation of serum TSH, FT4 with indicators of renal function （P〉0.05）. In OH group there was a negative correlation between FT3 and serum ereatinine concentrations （r=-0.40, P〈0.05）. In OH group there was not a correlation of FT3 with serum uric acid and urea （P〉0.05）.There was a positive correlation between TSH and serum ereatinine in simple S-PE group （r=0.20, P=0.04）. There was not a correlation between TSH and serum urea（r=0.04, P=0.65）, and serum uric acid （r=0.12, P=0.20）. Conclusions There was effect of different hypothyrosis state in pre-eclampsia patients on renal function. Serum uric acid, urea and ereatinine concentrations in S-PE pregnant women with OH were significantly higher than those in simple S-PE group with normal TSH. There was a negative correlation between FT3 and serum ereatinine in S-PE. Hence the thyroid function should be regularly monitored in S-PE patients to find damage of renal function and management hypothyrosis.