慢性肾脏病患者亚临床甲状腺功能减退症的研究进展

Research progress of subclinical hypothyroidism in patients with chronic kidney disease

慢性肾脏病(CKD)的患病率与发病率日益增长,已成为全球面临的严重公共卫生问题之一。在CKD病程进展中,常伴随甲状腺素合成、分泌、分解及代谢异常,表现为甲状腺功能减退症,其中以低T3综合征(LT3S)及亚临床甲状腺功能减退症(SCH)常见。目前研究结果表明,CKD与甲状腺功能减退症可能互为影响,CKD可引起甲状腺功能减退症,甲状腺功能减退症亦会导致CKD患者肾功能下降。CKD和终末期肾病(ESRD)中SCH可能与较高的心血管发病率和全因死亡率有关,是其不良结局的预测因素。但目前关于CKD患者SCH流行病学调查相关研究较少,且甲状腺素替代治疗的安全性及有效性迄今为止仍存在争议。本文就CKD与甲状腺功能减退症相互作用机制、CKD患者SCH的患病率及甲状腺素替代治疗对于CKD患者预后影响的研究进展进行阐述。

The prevalence and incidence of chronic kidney disease(CKD)is increasing,which has become one of the serious public health problems in the world.During the progression of CKD,thyroid hormone synthesis,secretion,de-composition and metabolism are often accompanied by abnormalities,characterized by hypothyroidism,which is common in low T3 syndrome(LT3S)and subclinical hypothyroidism(SCH).The research results show that CKD and hypothyroidism may influence each other.CKD can cause hypothyroidism,and hypothyroidism can also lead to the decrease of renal function in patients with CKD.In CKD and end-stage renal disease(ESRD),SCH may be associated with higher cardiovascular morbidity and all-cause mortality,which is a predictor of adverse outcomes.However,there are fewer studies on the SCH epidemiological investigation in patients with CKD.Up to now,the safety and efficacy of thyroxine replacement therapy are still controversial.In this paper,the mechanism of interaction between CKD and hypothyroidism,the prevalence of SCH in patients with CKD,and the influence of thyroid replacement therapy on the prognosis of patients with CKD were described.