小剂量甲状腺素补充对血液透析甲状腺功能异常患者临床指标的影响

Effect of low-dose levothyroxine supplementation on clinical parameters in patients with thyroid dysfunction receiving maintenance hemodialysis

目的探讨在维持性血液(MHD)透析合并甲状腺功能异常患者中使用小剂量左旋甲状腺素钠片对各项临床指标的影响。方法选取2018年10月31日至2021年10月31日在我院血液透析中心行MHD患者120例患者为研究对象,根据甲状腺功能分为正常组68例和异常组52例。对异常组患者补充小剂量左旋甲状腺素钠片治疗6个月。收集治疗前、治疗后3个月及治疗后6个月的各项临床指标游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)、血钙、血磷、甲状旁腺激素(PTH)、血胆固醇(TC)、血红蛋白(Hb)、血浆白蛋白(Alb)、C反应蛋白(CRP)以及左心室射血分数(LVEF)。比较正常组和异常组各项临床指标的差异;对比异常组治疗前、治疗后3个月、治疗后6个月的各项临床指标的差异。结果①血液透析患者中甲状腺功能异常发生率为43%;正常组和异常组年龄、性别、血钙、血磷、PTH比较差异无统计学意义(P>0.05),在透析时间、Hb、Alb、TC、CRP、FT3、TSH、LVEF之间比较差异有统计学意义(P<0.01)。②Pearson及Spearman相关分析显示,FT3与CRP、TC、透析时间呈负相关(r=-0.49,P<0.01;r=-0.31,P<0.01;r=-0.41,P<0.01),FT3与Alb、LVEF呈正相关(r=0.43,P<0.01;r=0.33,P<0.01)。③和治疗前比较,异常组治疗后3个月,TC和CRP明显降低,LVEF明显升高,差异有统计学意义(P<0.01),Hb、Alb、血钙、血磷、PTH比较差异无统计学意义;异常组治疗后6个月,Hb、ALb明显升高,差异有统计学意义(P<0.01)。结论MHD患者甲状腺功能异常的发生率高,对异常者补充小剂量左旋甲状腺素钠片可以改善血透患者的贫血、Alb,同时提高左心室收缩功能。

Objective To investigate the effect of low-dose levothyroxine supplementation on clinical parameters in patients with thyroid dysfunction receiving maintenance hemodialysis(MHD).Methods One hundred and twenty MHD patients in our hemodialysis center were recruited for the research.They were divided into normal group(68 cases)and abnormal group(52 cases)according to thyroid function.The abnormal group was treated with low-dose levothyroxine tablets for six months.Collect all the clinical data including dialysis time,sex,age,free T3(FT3),thyroid-stimulating hormone(TSH),hemoglobin(Hb),albumin(Alb),total cholesterol(TC),C-reactive protein(CRP),parathyroid hormone(PTH),left ventricular ejection fraction(LVEF)before and after treatment were collected.The differences in clinical indexes between the normal group and the abnormal group,and the differences in clinical indexes before and after treatment in the abnormal group were compared.Results The incidence of thyroid dysfunction in MHD patients was 43%.Sex,age,serum calcium,serum phosphorus and PTH were not significantly different between the normal group and abnormal groups(P>0.05),but there were significant differences in dialysis duration,FT3,TSH,Hb,Alb,TC,CRP and LVEF.Pearson and Spearman correlation analysis showed that FT3 was negatively correlated with CRP,TC and Dialysis duration(r=-0.49,P<0.01;r=-0.31,P<0.01;r=-0.41,P<0.01),FT3 was positively correlated with Alb and LVEF(r=0.43,P<0.01;r=0.33,P<0.01).Compared with the group before treatment,TC and CRP were significantly decreased and LVEF was significantly increased in abnormal group 3 months after treatment(P<0.01),but Hb,Alb,blood calcium,blood phosphorus and PTH had no significant differences.Hb and Alb were significantly increased in abnormal group 6 months after treatment(P<0.01).Conclusion The incidence of thyroid dysfunction in MHD patients is high.Low-dose levothyroxine supplementation can improve anemia,nutritional status,inflammation and left ventricular systolic function in hemodialysis patients with thyroid dysfunction.