慢性肾脏病患者肾小球滤过率与甲状腺素指标的相关性及并发甲状腺功能异常的危险因素分析

Correlation between glomerular filtration rate and thyroxine indicators in patients with chronic kidney disease and risk factors analysis of thyroid function abnormality

目的分析慢性肾病(CKD)患者肾小球滤过率与甲状腺功能指标之间的关系,探讨CKD患者并发甲状腺功能异常的危险因素。方法收集2020年5月至2021年5月在湖州市第一人民医院住院治疗的152例CKD患者的临床资料及实验室检测结果,根据肾小球滤过率(GFR)将患者划分为5个CKD分期组,即G1期组、G2期组、G3期组、G4期组和G5期组。采集空腹静脉血,检测血清甲状腺激素[总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(TT4)、血清游离甲状腺素(FT4)]、促甲状腺激素(TSH)、尿素氮(BUN)、血肌酐(Scr)和血尿酸(SUA)的水平,比较各组甲状腺激素、TSH、BUN、Scr和SUA水平的变化。结果各CKD分期组甲状腺功能异常率差异有统计学意义(P<0.05),G1期最低(8.3%),G5期最高(39.1%);各组TT3、FT3、TT4和FT4水平差异有统计学意义(P<0.05)。Spearman秩相关分析和线性散点图结果显示,GFR与TT3、FT3呈正相关(P<0.05),与TSH呈负相关(P<0.05),与TT4、FT4水平无直线相关关系(P>0.05)。多因素logistic回归分析显示,CKD分期为G3~G5期(OR=3.42,95%CI:1.23~9.51)和女性(OR=3.51,95%CI:1.37~9.02)是并发甲状腺功能异常的危险因素。结论不同分期CKD患者血清甲状腺功能指标可出现不同程度改变,CKD女性患者更易出现甲状腺功能异常,应监测CKD患者甲状腺素的变化情况,并采取有效的治疗措施,改善患者预后。

Objective To analyze the correlation between the glomerular filtration rate(GFR)and thyroid function indicators in the patients with chronic kidney disease(CKD),and to investigate the risk factors in the patients with CKD complicating thyroid function abnormality.Methods The clinical information and laboratory information of 152 patients with CKD admitted to this hospital from May 2020 to May 2021 were collected.The patients were divided into five CKD stage groups(G1,G2,G3,G4 and G5)according to GFR.The fasting venous blood was collected.The levels of serum thyroid hormone(TT3,FT3,TT4 and FT4),TSH,BUN,Scr and SUA levels were detected.The changes of thyroid hormones,TSH,BUN,Scr and SUA levels were compared among different groups.Results The abnormality rate of thyroid function had statistical difference among various CKD stage groups(P<0.05),which in the G1 stage was the lowest and which in the stage G5 was the highest;the levels of TT3,FT3,TT4 and FT4 had statistical difference among the various groups(P<0.05).The Spearman rank correlation analysis and linear scatter plot showed that GFR was positively correlated with the TT3 and FT3 levels(P<0.05),and negatively correlated with the TSH level(P<0.05),while had no linear correlation with the TT4 and FT4 levels(P>0.05).The multivariate logistic regression analysis showed that the stage G3-G5 in CKD classification(OR=3.42,95%CI:1.23-9.51)and female(OR=3.51,95%CI:1.37-9.02)were the risk factors for complicating hypothyroidism.Conclusion The thyroid function indicators in the patients with different CKD stages could have different depress of change,the female patients are easy to appear the thyroid function abnormality.Therefore the changes of thyroxine in the patients with CKD should be monitored,moreover the effective treatment measures should be adopted to improve the prognosis of the patients.