中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (03): 159-163.doi: 10.3969/j.issn.1671-4091.2016.03.009

• 临床研究 • 上一篇    下一篇

维持性血液透析患者甲状腺功能与残余尿量的关系研究

李根1,卢锦莲1,刘涛1,胡爱霞1,刘情操1,袁慧忠1   

  1. 湖北省黄石市黄石二医院(李根和卢锦莲对本文有同等贡献，为共同第一作者)
  • 收稿日期:2015-10-27 修回日期:2016-01-21 出版日期:2016-03-12 发布日期:2016-03-19
  • 通讯作者: 袁慧忠 ligen6496@163.com E-mail:yuanhuizhong2010@yahoo.com.cn
  • 基金资助:

    湖北省自然科学基金(2014CFC1038)

Clinical investigation on the relationship between thyroid hormones and residual urine volume in maintenance hemodialysis patients

  • Received:2015-10-27 Revised:2016-01-21 Online:2016-03-12 Published:2016-03-19

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摘要： 目的研究维持性血液透析(maintenance hemodialysis,MHD)患者的残余尿量(residual urine volume,RUV)与甲状腺功能的关系和相互影响。方法选取黄石市第二医院肾病内科2012 年10月～2014 年10 月透析时间大于12 月每周2 次血液透析的MHD 患者79 例为研究对象。分别收集患者的RUV、甲状腺激素(thyroid hormone,TH)、和其它临床资料。根据4 周内平均每天RUV 是否大于100ml 将其分为有残余尿组(RUV 组，n=22)和无残余尿组(NRUV 组,n=49)，比较2 组各指标的差异。多元logistic回归分析影响RUV 的重要因素。分析残余尿量与TH 的相关性。以游离三碘甲状腺原氨酸(free triiodothyronine, FT3)是否下降再将RUV 组分为2 亚组(A 亚组：FT3＞3.80pmol/l，B 组FT3≤3.8 pmol/l)随访2 组48 周，终点事件定为残余尿量小于平均100ml/24h；采用Kaplan-Meier 法分析2 组出现终点事件的概率差异。结果71 例患者纳入本研究，RUV 为70(130)ml。FT3为(3.67±0.56)pmol/L，下降的有43例(60.6%)；游离甲状腺素(free thyroxine,FT4)为8.65(1.5)pmol/L，下降的8 例(11.3%)；其中FT3 与FT4 均下降的有6 例(8.5%)；71 例患者人体促甲状腺激素(human thyroid-stimulating hormone,hTSH)为(2.69± 1.52 mIU/ml) 均正常。与NRUV 组比较，RUV 组透析年限[(1.75±2.03)年比(4.23±2.89)年,t=-4.153,P＜0.001)较短、FT3(3.87±0.41)pmol/L 比(3.58±0.54 )pmol/L, t= 2.444, P=0.018]平均值较高、透析充分性Kt/V[(1.27±0.06)比(1.23±0.08),t=2.183,P=0.032]较好、PTH[(181.95(244.35)pg/ml 比324.0(370.8)pg/ml, z=2.102, P= 0.036] 较低、透析中低血压(interdialyitc hypotension，IDH)频数[0.024(0.073)比0.097(0.150), z=2.166, P=0.030] 较低。多元logistic 回归分析得出FT3 (B=
1.983, P=0.002)、透析年限(B=-0.388，P=0.007)与RUV 密切相关。Spearman 等级偏相关性分析在去除透析年限因素影响后，FT3 与RUV 之间仍呈正相关，偏相关系数为0.603(P＜0.001)。随访中B 亚组更容易出现残余尿量的减少(Log rank χ2=9.748,P=0.002)。结论FT3和透析年限与MHD 患者RUV 密切相关，临床上应重视MHD患者FT3的变化。

关键词: 维持性血液透析, 残余尿量, 甲状腺激素

Abstract: Objective To investigate the relationship between thyroid hormones (TH) and residual urine volume (RUV) and their reciprocal influences in maintenance hemodialysis (MHD) patients. Methods We recruited 79 MHD patients treated twice a week for more than 12 months in the period from Oct. 2012 to Oct.
2014 in our hospital. Their clinical parameters including RUV and TH were collected. They were then divided into two groups based on RUV: RUV group (RUV ＞100ml/d, n=22) and NRUV group (RUV ＜100ml/d, n= 49). Clinical parameters were compared between the two groups. Factors influencing RUV were analyzed by using multivariate logistic regression. The relationship between TH and RUV was evaluated. The RUV group was further divided into two subgroups based on free triiodothyronine (FT3): subgroup A (FT3 ＞3.8 pmol/l) and subgroup B (FT3 ≤3.8 pmol/l). The two subgroups were followed up for one year (48 weeks), and the end points was the event of RUV ＜100ml/d. The probability difference about the occurrence of end points was evaluated by using Kaplan- Meier method. Results A total of 71 MHD patients with RUV of 70(130) ml were enrolled in this study. FT3 was 3.67±0.56 pmol/l in these patients, including 43 patients (60.6%) with lowered FT3. FT4 was 8.65(1.5) pmol/l in these patients, including 8 patients (11.3%) with lowered FT4. Six patients (8.5%) had both lowered FT3 and FT4. Seventy-one patients were assayed for TSH, and they were all normal. In RUV group, dialysis vintage was shorter (1.75±2.03 vs. 4.23± 2.89 years; t=-4.153, P＜0.001), FT3 was higher (3.87±0.41 vs. 3.58±0.54 pmol/l; t=2.444, P=0.018), Kt/V was higher (1.27±0.06 vs. 1.23±0.08; t=2.183, P= 0.032), PTH was lower [181.95(244.35) vs. 324.0(370.8) pg/ml; z=2.102, P=0.036], and the occurrence of interdialytic hypotension was lower [0.024(0.073) vs. 0.097(0.150); z=2.166, P=0.030], as compared with those in NRUV group. Multivariate logistic regression found that FT3 and dialysis vintage were correlated
significantly with RUV (B=1.983, P=0.002 for FT3; B=-0.388, P=0.007 for dialysis vintage). Spearman rank partial correlation analysis revealed that FT3 was positively correlated with RUV (R=0.603, P＜0.001) after excluding the factor of dialysis vintage. In the follow-up period we found that RUV decreased frequently
in the B subgroup of RUV group (χ2=9.748, P=0.002). Conclusions FT3 and dialysis vintage were significantly correlated with RUV in MHD patients. Clinically, we should pay attention to the change of FT3 in MHD patients.

Key words: maintenance hemodialysis, residual urine volume, thyroid hormones