维持性血液透析患者甲状腺激素的变化与认知障碍的相关性分析

发布时间：2018-04-29 01:00

本文选题：终末期肾脏病 + 血液透析　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:慢性肾衰竭患者普遍存在甲状腺功能紊乱,影响下丘脑-垂体-甲状腺轴及外周循环中的甲状腺激素的转化,常表现为低T3(三碘甲状腺原氨酸)或低T4(总甲状腺素)综合征,TSH水平不受影响,而这种甲状腺功能的紊乱的临床表现常常被尿毒症症状所掩盖。此外,维持性血液透析也会对甲状腺激素的代谢和循环产生影响。已知非甲状腺疾病患者的低T3或低T4状态会对认知功能产生影响,但对于终末期肾病患者的这种甲状腺功能紊乱,是否会对认知功能产生影响,尚缺乏报道。终末期肾病患者的认知障碍严重影响着患者的治疗进展和生活质量,本研究旨在调查维持性血液透析患者甲状腺激素水平的变化,并探究其对认知功能的影响。方法:选取河北医科大学第三医院肾内科于2014年10月至2014年12月行MHD的患者39例及住院慢性肾衰竭非透析患者(均为CKD5期患者)35例为研究对象。记录所有患者性别、年龄、透析龄、原发病等一般信息及MHD患者的透析前、后血压和透析过程中血压变化。采用中文版蒙特利尔量表评估患者的认知功能,若入组患者的受教育年限小于12年者则总分加1分,总分26分的患者被认为存在认知功能损害。同一调查员依据蒙特利尔量表标准指导语,对入组患者进行神经心理学量表测试,详细记录结果。所有量表完成时间均为患者接受透析治疗前。血样懫集时间均为患者行血液透析治疗前,未透析患者于测试当日清晨空腹采血。分析透析组和非透析组认知功能和甲状腺激素水平的差异;并根据年龄将透析组和非透析组分为老年组和非老年组两个亚组,分析两亚组患者认知功能和甲状腺激素水平的关系。结果:74例患者年龄为18岁~78岁,平均55.1±15.1岁。其中男性37例(50%),女性37例(50%),原发病为慢性肾小球肾炎者54例(72.9%)、糖尿病肾病者14例(18.9%)、高血压肾损害者4例(5.4%)、干燥综合征者1例(1.3%)、左肾透明细胞癌者1例(1.3%)。MHD患者透析龄为5~154月,平均34.2±31.4个月。74例患者全部完成了量表,平均得分为25.6±2.35,其中28例量表得分26分,认知功能损害发生率为37.83%。T3平均水平1.17±0.32nmol/l,44例存在低T3,发生率为59.5%。透析组和非透析组患者在T3水平上存在显著差异(P0.05),但在认知水平上无明显差异(P0.05)。透析组中,老年组和非老年组在认知功能和T3水平上存在显著差异(P0.05);老年组中认知损害组与认知正常组相比,原发病为糖尿病肾病、受教育时间,血钙、血磷水平存在差异(P0.05),但与T3水平无关(P0.05);非老年组中认知损害组与认知正常组参与者受教育程度、超滤量存在显著差异(P0.05),与T3水平无关(P0.05);透析组患者中T3正常与T3减低的血浆白蛋白水平和年龄构成上存在显著差异(P0.05)。非透析组中,老年组和非老年组在认知水平上存在显著差异(P0.05);老年组认知损害组与认知正常组相比,在受教育水平上存在显著差异(P0.05),与T3水平相关(P0.05);非老年组在受教育水平上存在显著差异(P0.05),与T3水平无关(P0.05)。非透析患者中T3正常与T3减低的患者血浆白蛋白水平和血钙水平上存在显著差异(P0.05)。结论:1终末期肾病患者普遍存在T3水平减低,血液透析治疗可以显著升高患者T3水平,但对认知功能无显著影响。2对于透析和非透析患者,T3水平主要与白蛋白水平相关。3透析患者认知水平主要与受教育程度相关,受教育时间越短发生认知损害可能性越大。而非透析组认知水平主要与年龄相关,年龄越大认知损害发生可能性越大。4维持性血液透析患者的低T3状态没有造成认知功能损害,无需采取甲状腺激素替代治疗。非透析老年患者的血清T3水平与认知得分相关,需要注意这些患者的甲状腺激素变化及认知功能的改变。
[Abstract]:Objective: there is a general presence of thyroid dysfunction in patients with chronic renal failure, affecting the transformation of thyroid hormones in the hypothalamus pituitary thyroid axis and peripheral circulation, often characterized by low T3 (three iodine thyroxine) or low T4 (total thyroxine) syndrome, and the level of TSH is not affected, and the clinical manifestations of this thyroid dysfunction often occur. It is covered by the symptoms of uremia. In addition, maintenance hemodialysis can also affect the metabolism and circulation of thyroid hormones. Low T3 or low T4 status in patients with non thyroid diseases is known to affect cognitive function, but whether the thyroid dysfunction in patients with end-stage renal disease may affect cognitive function is still lacking. Lack of reports. Cognitive impairment in patients with end-stage renal disease seriously affects the treatment progress and quality of life. The purpose of this study was to investigate the changes in thyroid hormone levels in maintenance hemodialysis patients and to explore their effects on cognitive function. Methods: the Department of nephrology in the Third Hospital of Hebei Medical University was selected from October 2014 to December 2014. 39 patients with MHD and 35 cases of chronic renal failure in non dialysis patients (all CKD5 patients) were studied. Record all patients' gender, age, age, age, primary disease and other general information as well as the changes of blood pressure and blood pressure in MHD patients before and after dialysis. The Chinese version of the Montreal scale was used to evaluate the cognitive function of the patients, if the patients were enrolled in the group. The total score of the patient was less than 12 years and the total score was 1 points, and the total score of 26 was considered to have cognitive impairment. The same investigator, based on the Montreal scale standard guidance, carried out a neuropsychological scale test for the patients in the group, and recorded the results in detail. Before the patients were treated with hemodialysis, the patients in the non dialysis group were collected on the morning of the morning on the day of the test. The differences in cognitive function and thyroid hormone levels between the dialysis group and the non dialysis group were analyzed, and the age group and the non dialysis group were divided into two subgroups of the elderly group and the non elderly group. The cognitive function and the thyroid function of the two subgroups were analyzed. Results: the relationship between adenoid hormone level. Results: the age of 74 patients was 18 years old ~78 years old, with an average of 55.1 + 15.1 years old. Among them, 37 cases (50%), 37 cases (50%), 54 patients with chronic glomerulonephritis (72.9%), 14 (18.9%) patients with diabetic nephropathy, hypertensive renal damage patients (5.4%), cases of dry syndrome, and left renal cell carcinoma patients. The age of.MHD patients was 5~154 months, and the average score of.74 patients was 25.6 + 2.35 in average 34.2 + 31.4 months. The average score of 28 cases was 26. The incidence of cognitive impairment was 1.17 + 0.32nmol/l, 44 cases had low T3, and the incidence was 59.5%. The dialysis group and non dialysis group were displayed on the T3 level. There was no significant difference (P0.05), but there was no significant difference in cognitive level (P0.05). In the dialysis group, there was a significant difference in the cognitive function and the level of T3 (P0.05) in the elderly group and the non elderly group (P0.05); the cognitive impairment group in the elderly group was compared with the cognitive normal group, the primary disease was diabetic nephropathy, the education time, blood calcium, and blood phosphorus levels were different (P0.05), but with T3 water. There was significant difference in the level of education between the cognitive impairment group and the cognitive normal group in the non elderly group (P0.05) and the level of T3 (P0.05). There were significant differences in the plasma albumin level and age composition between the normal T3 and the T3 decreased (P0.05) in the dialysis group (P0.05). In the non dialysis group, the elderly group and the non elderly group were in the non dialysis group. There were significant differences in cognitive level (P0.05). There were significant differences in the level of Education (P0.05) in the cognitive impairment group of the elderly group (P0.05) and the level of T3 (P0.05); there were significant differences in the level of Education (P0.05) in the non elderly group (P0.05). In non dialysis patients, the plasma of T3 normal and T3 decreased in the non dialysis patients. There was a significant difference in albumin level and blood calcium level (P0.05). Conclusion: 1 end-stage renal disease patients generally have decreased T3 level, and hemodialysis therapy can significantly increase the level of T3 in patients, but there is no significant effect on cognitive function in.2 for dialysis and non dialysis patients, and the level of T3 is mainly related to the level of cognitive level in patients with albumin level associated with.3 dialysis. The higher the educational level is, the shorter the cognitive impairment is, the greater the likelihood of cognitive impairment. The greater the age, the older the cognitive impairment is, the greater the age of the cognitive impairment, the lower the T3 status of.4 maintenance hemodialysis patients does not cause cognitive impairment and no need for thyroid hormone replacement therapy. Analysis of serum T3 level in elderly patients is related to cognitive score. Thyroid hormone changes and cognitive function in these patients need to be noted.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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