特发性膜性肾病患者甲状腺激素及25-羟维生素D水平的分析

Analysis of thyroid hormone and 25-hydroxyvitamin D levels in patients with idiopathic membranous nephropathy

目的探讨特发性膜性肾病患者中甲状腺激素和25-羟维生素D水平情况。方法回顾性分析2016—2017年度在新疆某三甲医院基于临床病理资料综合诊断为特发性膜性肾病患者的资料。结果 134例特发性膜性肾病患者中甲状腺功能异常89例(66.42%),25-羟维生素D缺乏129例(96.27%);在不同白蛋白水平分组中,白蛋白<25 g/L组甲状腺激素水平较低,差异有统计学意义(P<0.05),甲功异常组与甲功正常组相比白蛋白、钙、甲状腺激素[总三碘甲腺原氨酸(TT_3),总甲状腺素(TT_4),游离三碘甲腺原氨酸(FT_3),游离甲状腺素(FT_4)]水平较低,三酰甘油、总胆固醇和促甲状原激素(TSH)水平较高,差异有统计学意义(P<0.05);相关性分析显示白蛋白与甲状腺激素(TT_3、TT_4、FT_3、FT_4)水平呈正相关,25-羟维生素D与TT_4、FT_3、FT_4呈正相关(P<0.05),总胆固醇与甲状腺激素(TT_3、TT_4、FT_3、FT_4)呈负相关,与TSH呈正相关(P<0.05),钙与TT_4、FT_3、FT_4呈正相关(P<0.05);多元逐步回归显示白蛋白和24 h尿蛋白是25-羟维生素D的影响因素,钙、总胆固醇、25-羟维生素D和TT_4是白蛋白水平的影响因素。结论特发性膜性肾病伴有甲状腺功能紊乱的患者较甲状腺功能正常者病情严重,特发性膜性肾病患者中甲状腺激素水平降低与低蛋白血症、脂代谢异常和钙水平有关,在新疆地区特发性膜性肾病患者中25-羟维生素D缺乏非常普遍,建议早期治疗。

Objective To investigate the levels of thyroid hormone and 25-hydroxyvitamin D in patients with idiopathic membranous nephropathy.Methods A retrospective analysis of data from patients with idiopathic membranous nephropathy based on clinical pathological data in a tertiary Grade A hospital in Xinjiang between 2016-2017.Results A total 134 patients with idiopathic membranous nephropathy were included,among whom 89(66.42%)had thyroid dysfunction and 129(96.27%)had 25-hydroxyvitamin D deficiency.The thyroid hormone level in the low albumin group(Alb<25 g/L)were significantly lower than the other groups(P<0.05).Compare the thyroid dysfunction group with the normal thyroid function group,the levels of albumin,calcium,and thyroid hormones(TT3,TT4,FT3,and FT4)were significantly lower,and the levels of triglyceride,total cholesterol and TSH were significantly higher(P<0.05).Correlation analysis showed that albumin and thyroid hormone(TT3,TT4,FT3,and FT4)levels were significantly positively correlated(P<0.05);25-hydroxyvitamin D was significantly positively correlated with TT4,FT3,FT4(P<0.05);and total cholesterol was significantly negatively correlated with thyroid hormone(TT3,TT4,FT3,and FT4),and positively correlated with TSH(P<0.05).Calcium was significantly positively correlated with TT4,FT3 and FT4(P<0.05).Multiple stepwise regression showed that albumin and 24 h urine protein were the influencing factors of 25-hydroxyvitamin D.Calcium,total cholesterol,25-hydroxyvitamin D and TT4 were influencing factors of albumin level.Conclusion Patients with IMN and thyroid dysfunction are severer than those with normal thyroid function.The reduction of thyroid hormone in IMN patients is associated with hypoproteinemia,abnormal lipid metabolism and calcium levels.The lack of 25-hydroxyvitamin D in IMN patients is very common in Xinjiang.Early treatment is recommended.