MHD患者并发ESS的影响因素及ESS与炎性因子的关系分析

Influencing Factors of ESS in Patients with MHD and the Relationship Between ESS and Inflammatory Factors

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者并发正常甲状腺病态综合征(euthyroid sick syndrome,ESS)的影响因素及ESS与炎性因子的关系。方法回顾性分析2016年8月至2019年10月间收治的185例行MHD的慢性肾衰竭(chronic renal failure,CRF)患者临床资料,根据是否发生ESS分为ESS组(n=105)和非ESS组(n=80)。比较两组一般资料、透析相关因素、生化指标,分析炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]与甲状腺功能[血清三碘甲腺原氨酸(T3)、甲状腺素(T4)]的关系,采用Logistics回归分析影响MHD患者并发ESS的因素。结果①两组性别、年龄、平均动脉压、原发病、肾功能不全病程及透析时间对比,差异均无统计学意义(χ^2/t=0.109、0.727、1.136、1.433、0.189,P=0.741、0.468、0.725、0.153、0.189);②ESS组与非ESS组空腹血糖、血清白蛋白、血红蛋白、TSH水平对比差异无统计学意义(t=1.508、1.521、1.756、0.815,P=0.229、0.130、0.081、0.416),ESS组甲状旁腺素、IL-6和TNF-α水平均高于非ESS组,ESS组T3、T4水平均低于非ESS组(t=5.946、7.721、5.537、8.722、15.613,P均<0.001);③Pearson相关分析显示:IL-6、TNF-α分别与T3、T4均呈负相关关系(rT3=-0.423、-0.479,rT4=-0.372、-0.350,P<0.05);④Logistics回归分析显示:甲状旁腺素、IL-6、TNF-α均是影响MHD患者并发ESS的独立危险因素(P<0.05)。结论IL-6、TNF-α在MHD患者并发ESS中起重要作用,且其表达水平与患者甲状腺功能异常程度相关,甲状旁腺素也是影响患者发生ESS的独立危险因素。

Objective To investigate the influencing factors of euthyroid sick syndrome(ESS)in patients with maintenance hemodialysis(MHD)and the relationship between ESS and inflammatory factors.Methods The clinical data of 185 patients with chronic renal failure(CRF)who underwent MHD from August,2016 to October,2019 were retrospectively analyzed.These patients were divided into the ESS group(n=105)and non-ESS group(n=80)according to the occurrence of ESS.The general data,dialysis-related factors and biochemical indicators were compared between the two groups,and the relationship between inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]and thyroid function[serum triiodothyronine(T3),thyroxine(T4)]was analyzed,and logistics regression analysis was used to analyze the factors affecting ESS in MHD patients.Results There were no significant differences for the gender,age,mean arterial pressure,primary disease,duration of renal insufficiency and dialysis time between the two groups(χ^2/t=0.109,0.727,1.136,1.433,0.189,P=0.741,0.468,0.725,0.153,0.189).There were no significant differences for the levels of fasting blood glucose,serum albumin,hemoglobin and TSH between the ESS group and non-ESS group(t=1.508,1.521,1.756,0.815,P=0.229,0.130,0.081,0.416),and the levels of parathyroid hormone,IL-6 and TNF-αin the ESS group were higher than those in the non-ESS group(t=5.946,7.721,5.537,8.722,15.613,all P<0.001).Pearson correlation analysis showed that IL-6 and TNF-αwere negatively correlated with T3 and T4(rT3=-0.423,-0.479,rT4=-0.372,-0.350,P<0.05).Logistics regression analysis showed that parathyroid hormone,IL-6 and TNF-6 were independent risk factors affecting ESS in patients with MHD(P<0.05).Conclusion IL-6 and TNF-6 play an important role in ESS in patients with MHD,and their expression levels are related to the degree of thyroid dysfunction.