血液透析患者甲状腺功能与颈动脉硬化及左室结构相关性研究

发布时间：2018-04-23 21:48

本文选题：血液透析 + 甲状腺功能　；参考：《中国实用内科杂志》2016年07期

【摘要】：目的探讨维持性血液透析(MHD)患者甲状腺功能和颈动脉病变、左心室结构的变化及其之间的关系。方法选择2014年2月至2015年4月扬州市江都人民医院维持性血液透析患者100例,透析时间3个月以上,超声检查颈动脉病变,并测甲状腺功能,包括游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、促甲状腺素(TSH),并测定C反应蛋白(CRP),应用心脏超声心动图测定患者心脏功能指标等。分析患者临床资料、甲状腺功能和颈动脉病变以及心脏结构的关系。结果 (1)MHD患者甲状腺功能异常者41例(41%),以低FT_3为主,根据甲状腺功能分为异常组(41例)和正常组(59例),异常组CRP、颈动脉内膜中膜厚度(IMT)、颈动脉斑块和狭窄例数均高于正常组(P0.05)。异常组左心房内径(LAD)、左心室收缩期内径(LVEDd)、左心室舒张期期内径(LVEDs)、左心室舒张期后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室质量指数(LVMI)均高于阴性组(P0.05),而左心室射血分数(LVEF)低于阴性组(P0.05)。(2)MHD患者颈动脉斑块发生率41%(41/100),根据颈动脉彩色多普勒超声检查将患者分为颈动脉斑块阳性组(41例)和斑块阴性组(59例),颈动脉斑块阳性组IMT高于阴性组(P0.05),FT_3、FT_4水平低于阴性组而TSH高于阴性组。(3)根据是否合并LVH分为LVH组(45例)和非LVH组(55例)。与非LVH组相比,LVH组CRP、TSH明显升高,而FT_3、FT_4明显降低(P0.05)。(4)多因素Logistic回归分析显示,FT_3与颈动脉硬化、LVH呈负相关。结论维持血液透析患者中,常常伴有甲状腺功能异常,主要表现为FT_3下降。FT_3下降与颈动脉硬化和LVH发生密切相关。
[Abstract]:Objective to investigate the changes of left ventricular structure and thyroid function and carotid artery lesions in patients with maintenance hemodialysis (MHD). Methods 100 patients with maintenance hemodialysis in Jiangdu people's Hospital of Yangzhou City from February 2014 to April 2015 were selected. The duration of hemodialysis was more than 3 months. Carotid artery lesions were examined by ultrasound and thyroid function was measured. These include free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSHN), C-reactive protein (CRP), cardiac function index by echocardiography, and so on. The clinical data, thyroid function, carotid artery disease and cardiac structure were analyzed. Results there were 41 cases with abnormal thyroid function, 41 cases with hypothyroidism and 41 cases with abnormal thyroid function. According to thyroid function, 41 cases were divided into abnormal group (n = 41) and normal group (n = 59). The abnormal group, carotid intima media thickness (IMT), carotid plaque and stenosis were higher than those in normal group (P 0.05). Left atrial diameter (lad), left ventricular systolic diameter (LVED), left ventricular diastolic diameter (LVEDsN), left ventricular posterior wall thickness (LVPWTT), interventricular septal thickness (IVSTT) and left ventricular mass index (LVMIs) in abnormal group were higher than those in negative group (P 0.05), while left ventricular ejection fraction (LVEF) was lower. The incidence of carotid plaque in patients with MHD was 41 / 100. According to carotid color Doppler ultrasound, the patients were divided into carotid plaque positive group (41 cases) and plaque negative group (59 cases). The IMT of carotid plaque positive group was higher than that of negative group (P 0.05% FT3FT4 4). The level of TSH was lower than that of negative group, but TSH was higher than that of negative group.) according to whether the patients were complicated with LVH, they were divided into LVH group (n = 45) and non- group (n = 55). Compared with the non-LVH group, the CRP- TSH in the LVH group was significantly higher, while FT3 / FT4 was significantly lower than that in the non-LVH group. The multivariate Logistic regression analysis showed that there was a negative correlation between FTTi3 and the carotid arteriosclerosis. Conclusion in patients with hemodialysis, thyroid dysfunction is often associated with the decrease of FT_3. FT3 is closely related to carotid arteriosclerosis and LVH.
【作者单位】：扬州大学附属扬州市江都人民医院肾内科;第二军医大学附属上海长征医院肾内科解放军肾脏病研究所;
【基金】：“十二五”国家科技支撑计划课题(2011BAI10B08)
【分类号】：R459.5

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