慢性肾脏病患者低蛋白血症与甲状腺功能的相关因素分析

ANALYSIS OF RELATED FACTORS BETWEEN HYPOPROTEINEMIA AND THYROID FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

目的 探讨基于肾穿刺活检的慢性肾脏病(chronic kidney disease,CKD)患者白蛋白降低与甲状腺功能的相关因素分析。方法 回顾性分析2013年7月—2019年9月在四川大学华西医院肾脏内科行肾穿刺活检的CKD患者。依据白蛋白值将患者分为正常白蛋白组和低白蛋白组,比较分析二组患者的一般临床指标的差别,采用Spearman分析法分析CKD患者白蛋白降低与甲状腺功能指标的相关性。结果 共纳入311例CKD行肾穿刺活检患者,其中男性169例(54.3%),女性142例(45.7%);年龄(42.28±13.435)岁,白蛋白降低的患病率51.45%(160/311)。与正常白蛋白组相比,低白蛋白组的年龄、尿素、血清胱抑素C测定、甘油三酯、高密度脂蛋白、低密度脂蛋白、胆固醇、24小时尿蛋白、TSH[(45.46±14.562)岁vs (40.38±11.763)岁,P=0.001;(8.61±6.334)mmol/L vs(5.97±2.710)mmol/L,P<0.001;(1.43±0.806)vs(1.13±0.521),P<0.001;(2.49±1.514)mmol/L vs(2.00±1.366)mmol/L,P=0.003;(1.48±0.518)mmol/L vs(1.30±0.423)mmol/L,P=0.001;(4.60±2.180)mmol/L vs(2.81±0.91)mmol/L,P<0.001;(7.07±2.563)mmol/L vs(4.80±1.178)mmol/L,P<0.001;(7.71±5.361)mg/24hvs(1.86±2.175)mg/24h,P<0.001;(5.34±4.260)mIU/L vs(3.58±4.662)mIU/L,P=0.001)升高,血红蛋白、尿蛋白/尿肌酐、FT3、FT4(126.97±24.417)g/L vs(133.64±22.110)g/L,P=0.012;(1.21±1.615)mg/g vs(2.57±3.127)mg/g,P<0.001;(3.52±0.970)pmol/L vs(4.62±1.078)pmol/L,P<0.001;(13.42±3.082)pmol/L vs(16.40±4.0321)pmol/L,P<0.001)降低,差异均有统计学意义(P <0.05)。白蛋白与TSH成负相关(r=-0.195,P=0.001),与FT3、FT4成正相关(r=0.474,P<0.001vs r=0.385,P<0.001)结论 CKD患者白蛋白降低与甲状腺功能异常有关,积极关注CKD患者FT3、FT4、TSH可能有助于降低白蛋白降低的风险,改善CKD患者预后。

Objective To investigate the correlation between decreased albumin and thyroid function in patients with chronic kidney disease(CKD) based on renal biopsy.Methods Retrospective analysis was performed on CKD patients who underwent kidney biopsy in the Department of Nephrology,West China Hospital of Sichuan University from July 2013 to September 2019.Patients were divided into normal albumin group andlow albumin group according to the albumin value,and the differences in general clinical indicators of the two groups were compared and analyzed.Spearman analysis was used to analyze the correlation between reduced albumin and thyroid function indicators in CKD patients.Results A total of three hundred and eleven patients with CKD underwent kidney biopsy were included,including 169 males(54.3%) and 142 females(45.7%).At the age of(42.28±13.435) years,the incidence of albumin reduction was 51.45%(160/311).Compared with normal albumin group,age,urea,determination of serum cystatin C,triglyceride,HIGH-density lipoprotein,low-density lipoprotein,cholesterol,24-hour urinary protein,TSH(45.46±14.562) old vs(40.38±11.763) old,P=0.001;(8.61±6.334) mmol/L vs(5.97±2.710) mmol/L,P<0.001;(1.43±0.806) mmol/L vs(1.13±0.521) mmol/L,P<0.001;(2.49±1.514) mmol/L vs(2.00±1.366) mmol/L,P=0.003;(1.48±0.518) mmol/L vs(1.30±0.423) mmol/L,P=0.001;(4.60±2.180) mmol/L vs(2.81±0.91) mmol/L,P<0.001;(7.07±2.563) mmol/L vs(4.80±1.178) mmol/L,P<0.001;(7.71±5.361) mg/24 hL vs(1.86±2.175) mg/24 h,P<0.001;(5.34±4.260) mIU/L vs(3.58±4.662) mIU/L,P=0.001),hemoglobin,urinary protein/creatinine,FT3,FT4(126.97±24.417) g/L vs(133.64±22.110) g/L,P=0.012.(1.21±1.615) mg/g vs(2.57±3.127) mg/g,P<0.001;(3.52±0.970) pmol/L vs(4.62±1.078) pmol/L,P<0.001;(13.42±3.082) pmol/L vs(16.40±4.0321) pmol/L,P<0.001),both with statistically significant differences(P<0.05).Conclusion Decreased albumin in patients with CKD is associated with abnormal thyroid function.Active attention to FT3,FT4 and TSH in patients with CKD may help reduce the risk of albumin and improve the prognosis of patients with CKD.