低T3综合征可预测腹膜透析患者的不良预后

Low triiodothyronine syndrome can predict poor prognosis in peritoneal dialysis patients

目的·研究腹膜透析患者低T_3综合征(LT_3S)的发生情况,并探讨其对患者长期预后的预测价值。方法·入选2009年1月—2015年12月在上海交通大学医学院附属仁济医院腹膜透析中心开始维持性腹膜透析治疗且稳定腹膜透析≥3个月的慢性肾脏病患者477例,比较LT_3S组(218例)和正常T_3组(259例)患者生化指标。采用多因素Cox风险回归模型分析游离三碘甲状腺原氨酸(FT_3)对腹膜透析患者全因死亡、心血管疾病(CVD)死亡的预测价值。结果·与正常T_3组患者相比,LT_3S组血红蛋白[(97.90±23.71)g/L vs(105.54±22.94)g/L]、血校正钙[(2.06±0.35)mmol/L vs(2.17±0.27)mmol/L]均较低(均P<0.01),LT_3S组脑钠肽{[311.00(134.59,776.00)pg/mL]vs[159.00(58.28,378.75)pg/mL]}、高敏C-反应蛋白{[2.85(0.95,6.81)mg/L]vs[1.34(0.54,3.32)mg/L]}、总胆固醇[(3.18±1.29)mmol/L vs(2.76±0.93)mmol/L]均较高(均P<0.01);LT_3S组患者的左心室心肌质量指数{[(154.16±58.15)g/m^2]vs[(125.24±42.67)g/m^2],P<0.01}明显增高。多因素Cox风险回归模型显示,FT_3水平与腹膜透析患者全因死亡(HR 0.51,95%CI 0.41~0.63,P<0.01)和CVD死亡(HR 0.60,95%CI 0.45~0.81,P<0.01)独立相关。结论·腹膜透析患者LT_3S的发生率较高,低FT_3水平是腹膜透析患者全因死亡和CVD死亡的独立危险因素。

Objective · To investigate the prevalence of low triiodothyronine syndrome （LT3S） in peritoneal dialysis （PD） patients and to evaluate the predictive value of long-term prognosis. Methods · From Jan. 2009 to Dec. 2015, all patients who started PD for 3 months were enrolled. According to thyroid hormone levels, there were classified into LT3S group （218 cases） and normal T3 group （259 cases）. The association between FT3 and mortality in PD patients was estimated using Cox risk regression model. Results · Compared to the patients in normal T3 group, patients with LT3S had lower hemoglobin [（97.90±23.71）g/L vs （105.54±22.94）g/L], adjusted serum calcium [（2.06±0.35）mmol/L vs （2.17±0.27）mmol/L] （all P〈0.01）. Patients with LT3S had higher BNP {[311.00（134.59,776.00）pg/mL] vs [159.00（58.28,378.75）pg/mL]}, hrCRP {[2.85（0.95, 6.81）mg/L] vs [1.34（0.54, 3.32） mg/L]} and serum total cholesterol [（3.18±1.29）mmol/L vs （2.76±0.93）mmol/L] than that in patients with normal T3 group （all P〈0.01）. LVMI of LT3S group [（154.16±58.15）g/m2] vs （125.24±42.67）g/m2] was much higher than that of normal T3 group （P〈0.01）. Cox risk regression model indicated that FT3 was significantly associated with all-cause mortality （HR 0.51, 95% CI 0.41-0.63; P〈0.01） and cardiovascular mortality （HR 0.60, 95% CI 0.45-0.81; P〈0.01）. Conclusion · LT3S is common in PD patients. Lower FT3 was an independent risk factor of all-cause and cardiovascular mortality in PD patients.