微小病变型肾病患者甲状腺激素水平与糖皮质激素疗效的相关性研究

Correlation between thyroid hormone level and efficacy of glucocorticoid in patients with minimal change disease

目的研究微小病变型肾病(minimal change disease,MCD)患者甲状腺激素水平与糖皮质激素疗效的相关性。方法选取2016年1月至2019年5月在清远市人民医院肾内科住院治疗的55例MCD患者作为研究对象,对患者给予糖皮质激素治疗并进行随访。对患者经糖皮质激素治疗4周内、8周内缓解的影响因素进行单因素及多因素分析,纳入的变量包括年龄、性别、血红蛋白、血肌酐、血清白蛋白、24 h尿蛋白定量、谷丙转氨酶、谷草转氨酶、甘油三酯、总胆固醇、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、血清促甲状腺素,分析FT3、FT4、血清促甲状腺素与干预至缓解的时间的相关性,通过ROC曲线来评价影响因素预测患者4周内及8周内缓解的敏感性、特异性和最佳临界值。结果55例MCD患者FT3、FT4水平与干预至缓解的时间呈显著负相关(P<0.01),而血清促甲状腺素与缓解时间无明显相关性(P>0.05)。单因素分析显示,血肌酐、24 h尿蛋白定量、FT3、FT4是影响患者4周内缓解的因素;年龄、性别、血肌酐、24 h尿蛋白定量、FT3、FT4是影响患者8周内缓解的因素。多因素分析显示,FT3是对患者4周内及8周内缓解影响较大的独立因素。ROC曲线显示,FT3预测患者4周内、8周内是否缓解的最佳临界值为分别为2.38 pmol/L、2.23 pmol/L,敏感度分别为73.7%、73.9%,特异性分别为70.6%、88.9%。结论MCD患者的甲状腺激素FT3、FT4水平,尤其是FT3,与糖皮质激素的疗效存在一定相关性,FT3低下(伴或不伴FT4低下)可提示患者对糖皮质激素治疗的敏感性下降,FT3可以作为预测MCD患者经糖皮质激素治疗能否在4周内及8周内缓解的指标之一。

Objective To study the correlation between thyroid hormone level and efficacy of glucocorticoid in patients with minimal change disease(MCD).Methods A total of 55 patients with minimal change disease who hospitalized in Department of nephrology,Qingyuan People’s Hospital from January 2016 to May 2019 were selected as the study object.All the patient received glucocorticoid therapy and follow-up.Univariable analysis and multivariate analysis were used to analyze the influencing factors for remission with 4 weeks and 8 weeks of glucocorticoid therapy.The included variates included,age,gender,hemoglobin,serum creatinine,serum albumin,24-hour urine protein,glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase,triglycerides,total cholesterol,free triiodothyronine(fT3),free thyroxine(fT4),and serum thyrotrophin.Correlation between FT3,FT4,TSH and the time from intervention to remission was analyzed.By the ROC curve,the sensitivity,specificity and optical critical value of the variates with big influence coefficients in predicting remission within 4 weeks and within 8 weeks.Results In 55 patients with MCD,both FT3 and FT4 were significantly negatively correlated with the time from intervention to remission(P<0.01),but there was no significant correlation between serum thyrotrophin and the time from intervention to remission(P>0.05).Univariate analysis showed that serum creatinine,24-hour urine protein quantification,FT3,and FT4 were independent factors influencing remission within 4 weeks after glucocorticoid treatment;age,sex,serum creatinine,24-hour urine protein quantification,FT3,and FT4 were independent factors influencing patients'remission within 8 weeks.The result of the binary Logistic regression model showed that FT3 was an independent factor that had greater impact on patients'remission within 4 weeks and 8 weeks.The ROC curve showed that the optimal critical values for FT3 to predict the remission within 4 weeks and 8 weeks were 2.38 pmol/L and 2.23 pmol/L respectively,with the sensitivity 73.7%and 73.9%respectively,and the specificity of 70.6%and 88.9%respectively.Conclusions Thyroid hormone such as FT3,FT4,especially FT3,in patients with minimal change disease are correlative with the efficacy of glucocorticoid.Low FT3 level(with or without low FT4 level)may suggest decreased sensitivity to glucocorticoid,and FT3 can be used as one of the indicators to predict the remission of patients receiving glucocorticoid therapy within 4 weeks and 8 weeks.