维持性血液透析患者的甲状腺功能异常临床特点探究

Clinical characteristics of thyroid dysfunction in maintenance hemodialysis patients

目的观察维持性血液透析(maintenance hemodialysis,MHD)患者的甲状腺功能异常临床特点。方法选取合肥市第一人民集团医院滨湖医院2016年1月~2018年12月收治的128例行MHD的慢性肾脏病(chronic kidney disease,CKD)患者作为观察组,另选取64例同时期未进行透析的CKD患者作为对照组,按照甲状腺功能检测结果,将患者分别纳入甲状腺功能正常组、甲状腺功能异常组,分析甲状腺功能异常组正常甲状腺功能病态综合征(euthyroid sick syndrome,ESS)发生情况,对甲状腺功能正常组、不同类型ESS患者组的病程、透析龄、甲状腺功能、肾功能等各项指标的差异进行比较,观察患者甲状腺功能异常特点及其影响。结果观察组甲状腺功能异常、低血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)血症、低游离甲状腺素(free thyroxine,FT4)血症和低FT3、FT4血症发生率均高于对照组,差异有统计学意义(P<0.05)。低FT3血症组CKD病程、透析龄、FT3、甲状旁腺激素(parathyroid hormone,PTH)、白蛋白(albumin,ALB)、血红蛋白(hemoglobin,Hb)低于甲状腺功能正常组,其FT4高于后者;低FT4血症组FT3、PTH、尿素氮(urea nitrogen,BUN)、血肌酐(serum creatinine,sCr)高于甲状腺功能正常组,其FT3、TSH、ALB、Hb低于后者;低FT3、FT4血症组FT3、FT4、PTH、ALB、Hb均低于甲状腺功能正常组。Pearson相关性分析示,FT3与透析龄、PTH、Hb呈正相关,与ALB呈负相关;FT4与PTH呈负相关(P<0.05)。结论MHD患者甲状腺功能异常较为常见,且以低FT4血症为主,患者甲状腺功能变化与营养状态、贫血有关,建议开展早期干预。

Objective To observe the clinical characteristics of thyroid dysfunction in maintenance hemodialysis (MHD) patients. Methods 128 patients with chronic kidney disease(CKD) who underwent MHD in our hospital from January 2016 to December 2018 were selected as observation grou,another 64 patients with CKD who did not undergo dialysis at the same time were selected as control group. According to the results of thyroid function test,the patients were divided into normal thyroid function group and abnormal thyroid function group. The occurrence of Euthyroid sick syndrome(ESS) in abnormal thyroid function group was analyzed,and the normal thyroid function group and different types were compared. To explore the characteristics and effects of thyroid dysfunction in ESS patients,the differences of course of disease,dialysis age,thyroid function and renal function were analyzed. Results The incidence of thyroid dysfunction,low FT3,low FT4 and low FT3,FT4 in the observation group was higher than that in the control group,with statistical significance(P < 0.05). The course of CKD,dialysis age,Free triiodothyronine(FT3),Parathyroid hormone(PTH),Albumin(ALB) and Hemoglobin(Hb) in the hypo FT4 group were lower than those in the normal thyroid function group,and Free thyroxine(FT4) was higher than that in the latter;FT3,PTH,Urea nitrogen(BUN) and Serum creatinine(sCr) in the hypoFT4 group were higher than those in the normal thyroid function group,and FT3,TSH,ALB and Hb in the hypo FT3 and FT4 group were lower than those in the normal thyroid function group;FT3,FT4,PTH,ALB and Hb in the hypoFT3 and FT4 group were lower than those in the normal thyroid function group,the difference was statistically significant(P < 0.05). Pearson correlation analysis showed that FT3 was positively correlated with dialysis age,PTH and Hb,negatively correlated with ALB,and negatively correlated with FT4 (P < 0.05). Conclusion Thyroid dysfunction is common in MHD patients and is mainly caused by hypoFT4. The changes of thyroid function in MHD patients are related to nutritional status and anemia. Early intervention is recommended.