甲状腺功能减和血清FGF23对维持性血液透析患者心血管病变的影响

Effects of hypothyroidism and serum FGF23 on cardiovascular disease in maintenance hemodialysis patients

目的 探究维持性血液透析(MHD)患者心血管病变与甲状腺功能减退和血清成纤维细胞生长因子23(FGF)间的联系,以期为临床预防MHD患者心血管病变提供参考。方法 选取2020年2月至2022年12月济宁市第一人民医院收治的124例MHD患者为研究对象(MHD组),另选取同期体检健康人群50名作为健康对照组,比较两组血清FGF23水平、游离三碘甲状腺素FT_(3)(FT_(3))、游离四碘甲状腺素FT_(4)(FT_(4))和促甲状腺激素(TSH)水平;124例MHD患者根据电话或门诊随访记录心血管病变发生情况,将患者分为心血管病变组(发生心血管病变)53例和非心血管病变组(未发生心血管病变)71例,采用多元logistics回归分析MHD组患者发生心血管病变的危险因素;分析心血管病变组患者甲状腺功能指标、FGF23水平与心血管病变指标的相关性。结果 MHD组FT_(3)、FT_(4)水平低于健康对照组,FGF23、TSH水平高于健康对照组,差异有统计学意义(P<0.05);心血管病变组和非心血管病变组性别、年龄、透析血管通路、病程、体质量指数比较,差异无统计学意义(P>0.05),两组高血压、糖尿病、FT_(3)、FT_(4)、TSH和FGF23水平、颈动脉内膜中层厚度(IMT)、左心室质量指数(LVMI)比较,差异有统计学意义(P<0.05);多元Logistic回归分析结果显示,高血压、糖尿病、TSH、FGF23、LVMI、IMT升高、FT_(3)、FT_(4)降低均是导致MHD患者发生心血管病变的危险因素(P<0.05);心血管病变组患者TSH、FGF23与IMT、LVMI呈正相关性,FT_(3)、FT_(4)与IMT、LVMI呈负相关性(P<0.05)。结论 甲状腺功能减退和FGF23水平升高是MHD患者发生心血管病变的危险因素,通过定期检测甲状腺功能及FGF23水平,对降低心血管病变的发生风险有积极作用。

Objective To explore the relationship between cardiovascular disease,hypothyroid-ism and serum fibroblast growth factor 23(FGF)in maintenance hemodialysis(MHD)patients,in order to provide reference for clinical prevention of cardiovascular disease in MHD patients.Methods One hundred and twenty-four patients with MHD were admitted to our hospital from February 2020 to December 2022 and were selected for the cross-sectional study(MHD group).Another 50 healthy individuals who underwent physical examinations in our hospital during the same period were selected as the healthy control group.Serum FGF23 levels,free triiodothyronine FT_(3)(FT_(3)),free tetraiodothyronine FT_(4)(FT_(4)),and thyroid-stimulating hormone(TSH)levels were compared between the MHD group and the healthy control group.The 124 MHD patients were classified into 53 patients in the cardiovascular lesion group(with cardiovascular lesions)and 71 patients in the non-cardiovascular lesion group(without cardiovascular lesions)based on the occurrence of car-diovascular lesions recorded by telephone or outpatient follow-up;Multivariate logistic regression was used to analyse the risk factors for cardiovascular lesions in the MHD group.The correlation between thyroid function indexes,FGF23 levels and cardiovascular lesions in the cardiovascular lesion group was also analyzed.Results The levels of FT_(3) and FT_(4) in the MHD group were lower than those in the healthy control group,awhile the levels of FGF23 and TSH in the MHD group were higher than those in the healthy control group(P<0.05).Comparison of gender,age,dialysis vascular access,disease duration,and body mass index between the car-diovascular lesion group and the non-cardiovascular lesion group showed no statistically significant difference(P>0.05).However,comparisons of hypertension,diabetes mellitus,FT_(3),FT_(4),TSH,and FGF23 levels,carotid intima-media thickness(IMT),and left ventricular mass index(LVMI)between the two groups showed statistically significant differences(P<0.05).The results of multivariate logistic regression analysis showed that hypertension,diabetes mellitus,TSH,FGF23,LVMI,elevated IMT,and reduced FT_(3) and FT_(4) were risk factors for cardiovascular lesions in patients with MHD(P<0.05).Patients in the cardiovascular le-sion group exhibited a positive correlation between TSH and FGF23 and IMT and LVMI,and a negative corre-lation between FT_(3) and FT_(4) and IMT and LVMI(P<0.05).Conclusion Hypothyroidism and elevated FGF23 leves are risk factors for cardiovascular disease in MHD patients.Regular monitoring of thyroid func-tion and FGF23 levels can help reduce the risk of cardiovascular disease.