中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (10): 708-712.doi: 10.3969/j.issn.1671-4091.2014.10.008

• 临床研究 • 上一篇    下一篇

左甲状腺素钠片治疗合并有甲状腺激素水平下降的透析性低血压患者的临床疗效观察

李根1,卢锦莲1,袁慧中1,刘涛1,何伟1,刘情操1,胡爱霞1,杨雅文1,刘建社2,张春2   

  1. 1. 湖北省黄石市第二医院肾内科
    2. 湖北省武汉市华中科技大学同济医学院附属协和医院肾内科
  • 收稿日期:2014-03-10 修回日期:2014-06-06 出版日期:2014-10-12 发布日期:2014-10-21
  • 通讯作者: 卢锦莲 ligen6496@163.com E-mail:347146378@qq.com

Clinical observation of oral sodium levothyroxine in the treatment of intradialytic hypotension complicated with low serum thyroid hormone in maintenance hemodialysis patients

  • Received:2014-03-10 Revised:2014-06-06 Online:2014-10-12 Published:2014-10-21

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摘要： 目的研究左甲状腺素钠片治疗合并有甲状腺激素水平下降的维持性血液透析患者透析性低血压(intradialytic hypotension,IDH)的临床疗效及可能的机制。方法选取黄石二医院2012 年6 月～2013 年6 月血液透析中心有IDH 发作史且合并有甲状腺激素(thyroid hormones,TH)水平下降的患者共40 例作为研究对象。首先研究TH 水平与IDH 发作频数的关系。再随机分成2 组，分别将2 组中愿意接受左甲状腺素钠片(Levothyroxine Sodium，LT4)治疗的归为治疗组(n=19)，不愿接受LT4 治疗的归为对照组(n=18)。再研究2 组在治疗前后的IDH 发作频数和各观察指标的变化。服药方法:LT4(25ugqd)服用1 周后若无不良反应改为50ug qd 完成24 周疗程。服药过程中出现不适的将药物减量原用量的1/2～1/4，有明显副反应的停药。结果40 例有低TH 水平的占IDH 总例数的72.7%。40 例患者游离甲状腺素(free thyroxine,FT4)水平与IDH 发作频数有负相关性(R=-0.443，P=0.004).治疗组中1 例因出现胸闷心悸中途退出，2 例因IDH 缓解后自行停药。与对照组相比治疗组服药后的IDH 发作频数较前减少(0.10±0.052 比0.20±0.127，P=0.003)，游离三碘甲状腺原氨酸(free triiodothyronine,FT3)(4.63±0.765 比3.84±0.697 pmol/l, P= 0.003) 和白蛋白(ALB)(40.86±3.148g/L 比39.06±1.990g/L，P=0.045)增加均具有统计学意义。与治疗前相比治疗组以下指标：FT4(7.33±1.190pmol/L 比8.54 ± 1.399 pmol/L，P =0.009)，FT3(3.59±0.603 比4.63±0.765pmol/L，P＜0.001),血红蛋白(HGB) (69.89±21.891 比82.61±11.49 g/L,P =0.007)，白蛋白(ALB)(38.01 ± 3.050g/L 比40.86±3.148 g/L，P =0.009)，血清铁(7.26±3.27 mmol/L 比9.39±1.56 mmol/L，P =0.006)，左心室射血分数(LVEF)(49.32%±6.67%比51.63%± 6.87%，P =0.014)均较前增高。IDH 发作频数较前减少(0.10±0.052 比0.22±0.118，P＜0.001) 结论LT4 纠正合并TH 水平下降的IDH 患者的低TH 水平可有效减少的IDH 发作频数。这可能与提高了患者的心脏左室射血分数以及改善了患者的贫血以及低白蛋白血症有关。

关键词: 血液透析, 甲状腺激素, 透析性低血压

Abstract: Objective To investigate the clinical efficacy and mechanism of oral sodium levothyroxine (LT4) in the treatment of intradialytic hypotesion (IDH) complicated with low thyroid hormone (TH) in maintenance hemodialysis (MHD) patients. Methods We recruited 40 MHD patients with IDH and low serum TH for at least 3 months during the period from June 2012 to June 2013. The relationship between serum TH level and IDH frequency in MHD patients was evaluated. The patients were then divided into two groups, LT4 treatment group (n=19) and control group (without LT4 treatment, n=18). Changes of IDH frequency and clinical parameters after the therapy for 24 weeks were observed in the two groups. LT4 was administrated orally 25μg/day for one week at the beginning, and then increased to 50μg/day for 24 weeks if no side-effects were found. LT4 should be reduced to 1/2～1/4 of the original dosage when side-effects were present, and should be terminated when serious adverse reactions occurred. Results Low serum TH level was found in 72.7% MHD patients with IDH. In the 40 MHD patients with IDH and low TH, free thyroxine (FT4) was negatively correlated with IDH frequency (R=-0.443, P=0.004). LT4 therapy terminated in 3 patients because of chest distress and palpitation in one case and no IDH anymore in 2 cases. In LT4 treatment group, IDH frequency reduced (0.10±0.052 vs. 0.20 ± 0.127, P=0.003) with the increases of free triiodothyronine (FT3) (4.63±0.765 vs. 3.84±0.697 pmol/l, P=0.003) and serum albumin (40.86±3.148 vs. 39.06±1.990 g/L, P=0.045), as compared with those in control group. Compared with the parameters before LT4 treatment, MHD patients after LT4 therapy showed the changes of FT4 (7.33 ± 1.190pmol/L, to 8.54 ± 1.399 pmol/L, P=0.009), FT3 (3.59 ± 0.603pmol/L to 4.63±0.765 pmol/L, P＜0.001), hemoglobin (69.89 ± 21.891 g/L to 82.61±11.49 g/L P=0.007), albumin (38.01±3.050g/L to 40.86±3.148 g/L, P=0.009), serum iron (7.26±3.27mmol/L to 9.39±1.56 mmol/L, P=0.006), left ventricular ejection fraction (49.32%±6.67% to 51.63%±6.87%, P=0.014), and IDH frequency (0.22±0.118 to 0.10±0.052, P＜0.001). Conclusion Oral LT4 therapy can reduce IDH frequency in MHD patients with low serum TH level. The effects of LT4 may relate to the increase of LVEF and improvement of anemia and nutrition status in these patients.

Key words: hemodialysis, thyroid hormone, intradialytic hypotension