慢性肾脏病患者脂质代谢紊乱危险因素分析  

Correlation between serum thyroid hormone and lipid in patients with chronic kidney disease

作　　者：黄海明[1] 肖晓芬[1] 王小琴[2] 

机构地区：[1]湖北中医药大学2013级硕士研究生,武汉430061 [2]湖北省中医院肾内科,武汉

出　　处：《临床肾脏病杂志》2015年第12期714-719,共6页Journal Of Clinical Nephrology

基　　金：“十二五”国家科技支撑计划(NO.2013BAI02B04)

摘　　要：目的探讨慢性肾脏病（chronic kidney disease，CKD）3～5期患者血清甲状腺素（thyroid hormone，TH）水平的变化与血脂代谢的关系及其临床意义。方法选择在我院住院治疗的CKD3～5期患者120例，根据CKD不同分期将其分为CKD3期组（76例）、CKD4期组（28例）、CKD5期组（16例）。另选择我院50名同期健康体检者为对照组，采用放射免疫法分别检测CKD患者与健康体检者血清游离三碘甲状腺原氨酸（free triiodothyronine，FT3）、游离甲状腺素（free thyroxine，FT4）、超敏促甲状腺素（sensitive thyroid stimulating hormones，sTSH）的含量，同时采用全自动生化分析仪测定其血总胆固醇（serum total cholesterol，TC）、三酰甘油（triglycerides，TG）、高密度脂蛋白胆固醇（high density lipoprotein，HDL-C）、低密度脂蛋白胆固醇（low density lipoprotein，LDL-C）、血肌酐（SCr）、尿素氮（BUN）、尿酸（uric acid，UA）、血红蛋白（hemoglobin，Hb）、血白蛋白（albumin，Alb）等，运用美国慢性肾脏病流行病合作工作组新开发的公式方程估算肾小球滤过率（estimated glomerular filtration rate，eGFR）。结果CKD3～5期患者血清FT3、FT4、eGFR低于正常对照组（P〈0．05），TSH与对照组比较，无统计学差异（P〉0．05）；血清TG、TC、LDL-C高于正常对照组（P〈0．05），HDL-C低于对照组，但差异无统计学意义（P〉0．05）。Pearson相关性分析显示，CKD患者血清FT3分别与TG、TC呈负相关（r=-0．288，P〈0．05；r=-0．312，P〈0．05），与eGFR、HDL-C、Alb、Hb呈正相关（r=0．356，P〈0．01；r=0．199，P〈0．05；r=0．266，P〈0．01；r=0．276，P〈0．01）；FT4分别与TC、LDL-C呈负相关（r=-0．199，P〈0．01；r=-0．297，P〈0．05），与eGFR、Alb、Hb呈正相关（r=0．405，P〈0．01；r=0．237，PGO．01；r=0．24，P〈0．01）；与TG、HDL-C均无明显相关性（P〉O．05）；sTSH与AlObjective To study the changes of serum thyroid hormone（TH） and the underlying effects on lipid in patients with chronic kidney disease（CKD） stage3-5. Methods Serum free triiodothyronine（FT3）, free thyroxine（FT4）, and sensitive thyroid stimulating hormones（s-TSH） concentrations in 120 patients with CKD stage3-5 in hospital and 50 normal-control subjects were measured by a specific radioimmunoassay. Serum total cholesterol（TC）, triglycerides （TG）, high density lipoprotein（HDL-C）, low density lipoprotein （LDL-C）, serum creatinine （SCr）, blood urea nitrogen （BUN）, uric acid（UA）, albumin（Alb） concentrationswere measured by a automatic biochemical analyzer, estimated glomerular filtration rate（eGFR） were measured by SCr. Results According to the analysis, serum contents of both FT3 and FT4 were significantly lower in patients with CKD stage3-5 than in normal controls（P〈0. 01 ,P〈0. 05, respectively）, and their s-TSH contents were not different compared with normal controls（P〉0. 05）. CKD patients had significantly higher serum TG, TC and LDL-C contents than normal controls （P〈0. 01, P〈0. 01, P〈0. 05, respectively）, but their HDL-C content is not more different than normal controls （P〈0. 05）. Pearson correlation analysis revels negative correlation betweeen FT3 and TG, TC （r= - 0. 288,P〈0. 05;r= - 0. 312,P〈0. 05）, but positive correlation between FT3 and HDL-C, Alb, Hb （r= 0. 356,P〈0. 01 ;r= 0. 199,P〈0. 05; r = 0. 266,P〈0. 01 ; r = 0. 276, P〈0. 01 ）. Negative correlation betweeen TC, LDL-C and FT4 were found（r= -0. 199,P〈0. 01;r = -0. 297,P-0. 05）, and positive correlation between FT4 and eGFR, Alb, Hb （r= 0. 405,P〈0. 01 ;r= 0. 237,P〈0. 01 ;r= 0. 24,P〈0. 01）, but there is no evidence correlaiton between FT4 and TG, HDL-C, eGFR, TG, TC, HDL-C, LDL-C are not correlated with s-TSH, except Alh. The results of regressive analysis showed that the independent risk factor of hyperlipidemia was eGFR and FT3, t

关 键 词：慢性肾脏病 甲状腺素 血脂 

分 类 号：R692[医药卫生—泌尿科学]