慢性肾衰竭患者甲状腺激素水平的变化及临床意义

The changes of serum thyroid hormone in patients with chronic renal failure and its clinical significance

目的了解慢性肾衰竭患者甲状腺激素水平与病情的关系。方法选取本院82例慢性肾衰竭患者为观察组,40名同期体检的健康者为对照组,用化学发光免疫法测定血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺素(TSH)水平。结果观察组各期慢性肾衰竭患者的血清T3、FT3水平与对照组比较差异均有统计学意义(P<0.01);T4和FT4水平除肾功能不全代偿期外,其他各期与对照组比较亦差异有统计学意义(P<0.01);而TSH水平则与对照组无差别(P>0.05)。尿毒症期患者的T4、FT3水平显著低于肾功能不全代偿期患者(P<0.01),FT4水平与其他各期的患者比较差异有统计学意义(P<0.01)。结论慢性肾衰竭患者常出现甲状腺激素水平异常,主要表现为低T3、低T4综合征;慢性肾衰竭患者甲状腺激素水平的测定对于判断病情、估计预后、指导治疗有一定的价值。

Objective To investigate the relationship between the changes of serum thyroid hormone in patients with chronic renal failure and the patients＇ conditions. Methods 82 patients with chronic renal failure in our hospital were selected as Observation Group, and 40 healthy persons in physical examination at the same period were selected as Control Group. Serum triiodothyronine（T3）, tetraiodothyronine（T4）, free triiodothyronine（FT3）, free tetraiodothyronine（FT4） and thyrotropin（TSH） level were determined by chemiluminescent immunoassay. Results There was statistical significance between patients with chronic renal failure at all stages in Observation Group and Control Group in terms of serum T3 and FT3 level（P〈0.01）; there was also statistical significance between patients with chronic renal failure at the stages other than compensatory stage of renal insufficiency in Observation Group and Control Group in terms of T4 and FT4 level（P〈0.01）; there was no difference between Observation Group and Control Group in terms of TSH level（P〉0.05）. T4 and FT3 level of patients at uraemia period was significantly lower than that of patients at compensatory stage of renal insufficiency（P〈0.01）, and FT4 level of patients at uraemia period was statistically difference from that of patients at other stages（P〈0.01）. Conclusion Abnormal thyroid hormones level is very common in patients with chronic renal failure, mainly manifesting as low T3 or low T4 syndrome; The detection of serum thyroid hormone in patients with chronic renal failure can be of certain significance for the judgment of disease conditions, prognosis evaluation and treatment guidance.