中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (07): 512-516.doi: 10.3969/j.issn.1671-4091.2022.07.011

• 临床研究 • 上一篇    下一篇

维持性血液透析患者甲状腺功能特点及其与心脏结构与功能的关系

吴 迪    刘宏超   王光璞    孙京华    蒋甘孺     尹忠诚   

  1. 221006 徐州，1徐州医科大学附属医院肾内科

  • 收稿日期:2021-08-31 修回日期:2022-01-01 出版日期:2022-07-12 发布日期:2022-07-12
  • 通讯作者: 尹忠诚 E-mail:yzcxyfy@126.com

Characteristics of thyroid function and the relationship with cardiac structure and function in maintenance hemodialysis patients 

  1. Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
  • Received:2021-08-31 Revised:2022-01-01 Online:2022-07-12 Published:2022-07-12

PDF

76

摘要： 目的 分析MHD患者甲状腺功能特点及其与心脏结构与功能的关系。 方法 选取2019年1
月～2020年12月于徐州医科大学附属医院规律血液透析且时间超过3月的患者共83例，分析其甲状腺
功能特点、心脏结构和功能及之间的关系。 结果 83 名患者中出现甲状腺功能异常共 30 例，占比
36.1%，以单纯游离三碘甲状腺原氨酸(FT3)下降及单纯促甲状腺激素(TSH)升高占比最大，分别为10.8%
和13.3%；甲状腺功能异常组高密度脂蛋白低于甲状腺功能正常组(t=2.594,P=0.011)，血清低密度脂蛋
白(t=2.520，P=0.015)、三酰甘油(Z=-2.796，P=0.005)、C-反应蛋白(CRP)(Z=-2.067，P=0.009)高于甲状
腺功能正常组，左心房内径(t=2.373，P=0.020)、左心室舒张期末径(t=2.390，P=0.021)、左心室舒张期后
壁厚度(t=2.561，P =0.014)、室间隔厚度(t=2.688，P=0.010)、左心室质量指数(t=3.785,P＜0.001)高于
甲状腺功能正常组，左心室射血分数低于甲状腺功能正常组(t=3.721，P＜0.001)。左心室肥厚者年龄
(t=2.159,P =0.034)、透析龄(Z =-2.769，P =0.006)、CRP(Z=-4.196，P＜0.001)、低密度脂蛋白(t=3.059,
P =0.003
)、甲状旁腺激素(PTH)(Z =-2.139,P =0.032)、TSH(Z=-2.827，P=0.005)高于无左心室肥厚者，血红
蛋白(t=2.616，P=0.011)、前 白 蛋 白 (t=2.515,P =0.014)、白 蛋 白 (t=2.643，P=0.010)、FT3(t=4.581，
P＜0.001
)、FT4(t=3.693，P＜0.001)低于无左心室肥厚者 ；二元 Logistic 分析显示 FT3(B=-1.195，
OR =0.303，95% CI 0.128～0.713，P=0.006
)、FT4(B=-0.427，OR =0.653，95%CI 0.487～0.875,P=0.004)

为发生左心室肥厚的保护因素。 结论
降为发生左心室肥厚的危险因素。 		MHD患者中单纯FT3下降及单纯TSH升高多见，且FT3、FT4的


关键词:

甲状腺功能, 心脏结构, 维持性血液透析

Abstract: Objective To analyze the characteristics of thyroid function and the relationship with cardiac
structure and function in maintenance hemodialysis (MHD) patients. Methods A total of 83 patients on regular hemodialysis for more than 3 months at The Affiliated Hospital of Xuzhou Medical University during the
period from January 2019 to December 2020 were enrolled in this study. Thyroid function characteristics of
the patients and the relationship with heart structure and function were analyzed. Results Thyroid dysfunction was found in 30 (36.1%) cases, of which most had a decrease of FT3 (10.8%) and an increase of TSH
(13.3% ). Compared with the thyroid normal group, HDL (t=2.594 P=0.011) was lower, and serum LDL
(t=2.520 P=0.015), triglycerides (Z=2.796, P=0.005) and C-reactive protein (CRP) (Z=2.067, P=0.009) were
higher in the thyroid dysfunction group; in addition, the left atrium diameter (t=2.373, P=0.020), left ventricular diastolic end diameter (t=2.390 P=0.021), left ventricular posterior diastolic wall thickness (t=2.561,
P=0.014), interventricular septal thickness (t=2.688, P=0.010) and left ventricular mass index (t=3.785,
P＜0.001) were higher, and the left ventricular ejection fraction (t=3.721, P＜0.001) was lower in the thyroid
dysfunction group. Patients with left ventricular hypertrophy had older age (t=2.159, P=0.034), longer dialysis
age (Z=2.769, P=0.006), higher levels of CRP (Z=4.196, P＜0.001), LDL (t=3.059, P=0.003), parathyroid hormone (PTH) (Z=2.139, P=0.032) and TSH (Z=2.827, P=0.005), but lower levels of hemoglobin (t=2.616,
P=0.011), pre- albumin (t=2.515, P=0.014), albumin (t=2.643, P=0.010), FT3 (t=4.581, P＜0.001) and FT4
(t=3.693, P＜0.001), as compared with those in the patients without left ventricular hypertrophy. Binary logistic analysis showed that hemoglobin (B=0.034, OR=0.967, 95% CI 0.939～0.995, P=0.022), FT3 (B=1.195,
OR=0.303, 95% CI 0.128～0.713, P=0.006) and FT4 (B=0.427, OR=0.653, 95% CI 0.487～0.875, P=0.004)
were the protective factor for patients to have normal left ventricular thickness. Conclusion Lower FT3 and
higher TSH are common in MHD patients, and are the risk factors for left ventricular hypertrophy in MHD patients.

Key words: Thyroid function; , Heart structure; , Maintenance hemodialysis

中图分类号: