中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (05): 366-369,391.doi: 10.3969/j.issn.1671-4091.2025.05.002

• 临床研究 • 上一篇    

维持性血液透析患者低FT3水平和睡眠障碍独立相关

文罗娜    何晓娇    李 双    邱振梁    钟小仕   

  1. 510220 广州，暨南大学附属广州红十字会医院1临床病态营养研究所 2肾内科
  • 收稿日期:2024-09-26 修回日期:2025-02-02 出版日期:2025-05-12 发布日期:2025-05-12
  • 通讯作者: 钟小仕 E-mail:2453075701@qq.com
  • 基金资助:
    广州市科技计划项目(2023A03J0516，2023A04J1278)；广州市卫生健康科技一般引导项目(20231A010017，20221A011017，20221A011018)；广州市红十字会医院前沿技术建设项目(GZRCH2023JS01)

Low FT3 levels independently associated with sleep disturbance in maintenance hemodialysis patients

WEN Luo-na, HE Xiao-jiao, LI Shuang, QIU Zhen-liang, ZHONG Xiao-shi   

  1. Institute of Disease-Oriented Nutritional Research, 2Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510220, China
  • Received:2024-09-26 Revised:2025-02-02 Online:2025-05-12 Published:2025-05-12
  • Contact: 510220 广州，暨南大学附属广州红十字会医院2肾内科 E-mail:2453075701@qq.com

摘要： 目的  探讨维持性血液透析(maintenance hemodialysis，MHD)患者睡眠障碍与甲状腺功能之间的关系。 方法 采用单中心横断面研究，纳入2023年11月在暨南大学附属广州红十字会医院血液净化中心规律行MHD的患者。收集患者的一般资料、透析前血液检查资料、用药情况，并收集患者透析前血清以检测甲状腺功能相关指标，以匹兹堡睡眠质量指数(Pittsburgh sleep quality index，PSQI)量表评估患者睡眠质量。 结果 共纳入患者126例，其中睡眠正常组65例(51.6%)，睡眠障碍组61例(48.4%)。单因素二元Logistic回归分析显示，连续变量中较低的血清游离三碘甲状腺原氨酸(FT3)水平(OR=0.332，95% CI: 0.178～0.620，P=0.001)、较长的透析龄(OR=1.018，95% CI:1.007～1.030，     P=0.001)，以及分类变量中FT3＜3.4 pmol/L(OR=3.201，95% CI:1.222～8.390，P=0.018)、服用安眠药物(OR=5.658，95% CI:2.310～13.861，P＜0.001)均与睡眠障碍相关。血清游离四碘甲状腺原氨酸、促甲状腺激素水平和睡眠障碍的关联无统计学意义。在多因素二元Logistic回归中，调整了年龄、性别、透析龄、Kt/V、服用安眠药物后，发现血清FT3＜3.4 pmol/L与睡眠障碍仍然相关(OR=3.225，95% CI:1.229～8.464，P=0.017)。 结论  MHD患者较低的血清FT3和睡眠障碍独立相关，但两者的关联仍需前瞻性研究进一步确认。

关键词: 慢性肾脏病, 维持性血液透析, 游离三碘甲状腺原氨酸, 睡眠障碍, 匹兹堡睡眠质量指数

Abstract: Objectives To investigate the association between sleep disturbance and thyroid function in maintenance hemodialysis (MHD) patients. Methods This was a single-center and cross-sectional study. Patients regularly undergoing maintenance hemodialysis at the Blood Purification Center in Guangzhou Red Cross Hospital of Jinan University in November 2023 were enrolled. Demographic data, pre-dialysis laboratory parameters, medication history were collected, and pre-dialysis serum samples were collected for thyroid function tests. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results  In total, 126 patients were enrolled, with 65 (51.6%) patients in the normal sleep group and 61 (48.4%) patients in the sleep disturbance group. Univariate binary logistic regression showed that continuous variables including lower serum free triiodothyronine (FT3) levels (OR=0.332,95% CI:0.178～0.620, P=0.001) and longer dialysis vintage (OR=1.018, 95% CI:1.007～1.030,P=0.001), as well as categorical variables including FT3 ＜3.4 pmol/L (OR=3.201,95% CI:1.222～8.390, P=0.018) and use of sleep medications (OR=5.658,95% CI:2.310～13.861,P＜0.001) were all associated with sleep disturbance. However, there was no significant association between serum free thyroxine, thyroid-stimulating hormone levels, and sleep disturbance. After adjusted for age, sex, dialysis vintage, Kt/V, and use of sleep medications, the multivariate binary logistic regression showed serum FT3＜3.4 pmol/L (OR=3.225，95% CI:1.229～8.464，P=0.017) was still associated with sleep disturbance. Conclusion Lower serum FT3 levels and sleep disturbance were independently associated in MHD patients. However, prospective studies are needed to confirm the results. 

Key words: Chronic kidney disease, Maintenance hemodialysis, Free triiodothyronine, Sleep disturbance, Pittsburgh sleep quality index

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