超声对不同透析手段治疗下的终末期肾病患者甲状腺的观察

发布时间：2018-03-02 17:27

本文选题：超声　切入点：甲状腺　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文应用高频超声对血液透析、腹膜透析及非透析手段治疗的终末期肾病患者进行甲状结构的观察,探讨终末期肾病患者及不同透析方式下甲状腺结构和功能的异常,为临床提供客观依据。方法:选取2015年5月-2016年10月期间,吉林大学第二医院肾内科收治住院的终末期肾病患者(end-stage renal disease,ESRD),共96例。根据患者接受透析治疗方式的不同,分为三组:进行血液透析(hemodialysis,HD)的患者,共50例;进行腹膜透析(continuous ambulatory peritoneal,CAPD)的患者,共24例;未行透析的患者,共22例。选择同期本院体检的正常人群37例作为对照组。根据甲状腺内是否有结节将透析组患者分为两个亚组:甲状腺有结节组,共49例;甲状腺无结节组,共25例。回顾性记录所有患者的年龄、性别组成、原发病诊断,所有患者均在本院行甲状腺超声检查,应用PHILIPS公司的i E33高频二维超声对甲状腺进行观察,测量甲状腺各径线,观察甲状腺内部回声,是否存在结节,按照相应标准判断是否有甲状腺肿大和结构改变。同时检测患者的肾功能,测定其甲状旁腺激素水平,测定其甲状腺功能,包括血清总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(TT4)、游离甲状腺素(FT4),促甲状腺素(TSH)。结果:1.HD组、CAPD组、未透析组的甲状腺体积、甲状腺肿大率均较正常组明显增加(P0.05);2.HD组、CAPD组、未透析组的甲状腺结构异常率、甲状腺结节发生率均较正常组明显增加(P0.05);HD组多发性甲状腺结节的发生率较CAPD组、未透析组明显增高(P0.05);HD组和CAPD组甲状腺实性结节的发生率较正常组明显增高(P0.05),未透析组甲状腺囊实混合性结节发生率较正常组明显增高(P0.05)。3.HD组、CAPD组、未透析组的甲状腺功能异常率、低T3综合征的发生率均较正常组明显增加(P0.05);HD组、CAPD组、未透析组的TT3、FT3水平均较正常组明显降低(P0.05)。4.终末期肾病患者的甲状腺结节易出现在女性和年龄大的患者中。结论:1.与正常人相比,终末期肾病患者容易出现甲状腺结构和功能的异常。2.不同透析手段对终末期肾病患者甲状腺结构和功能异常的改善无明显差异。3.应用高频超声可以客观评价终末期肾病患者甲状腺结构的改变,结合甲功可以提供终末期肾病患者甲状腺异常的全面信息,为临床治疗及判断预后提供依据。
[Abstract]:Objective: to observe the thyroid structure in patients with end-stage nephropathy treated with hemodialysis, peritoneal dialysis and non-dialysis with high-frequency ultrasound, and to explore the abnormal structure and function of thyroid gland in patients with end-stage nephropathy and in different dialysis modes. Methods: from May 2015 to October 2016, 96 patients with end-stage renal disease of end-stage renal disease were treated in Department of Renal Medicine, second Hospital of Jilin University. They were divided into three groups: 50 patients with hemodialysis (HD), 24 patients with continuous peritoneal ambulatory on dialysis (CAPDD), and 24 patients without hemodialysis. A total of 22 patients were selected as control group. According to whether there were nodule in thyroid, dialysis group was divided into two subgroups: thyroid nodule group (49 cases), thyroid nodule group (49 cases), thyroid nodule group (49 cases), thyroid nodule group (49 cases), thyroid nodule group (49 cases). The age, sex composition, primary diagnosis of all the patients were retrospectively recorded. All the patients were examined by thyroid ultrasound in our hospital. The thyroid was observed and measured by PHILIPS's iE33 high-frequency two-dimensional ultrasound. To observe the internal echo of thyroid, whether there were nodules, to judge whether there were goiter and structural changes according to the corresponding criteria, and to examine the renal function, the level of parathyroid hormone and the thyroid function of the patients. Serum total triiodothyronine (TTT), free triiodothyronine (FT3), total thyroxine (TT-4), free thyroxine (FT4), thyrotropin (TSH), thyrotropin (TSH) were measured. Results 1. Thyroid volume in CAPD group, CAPD group and non-dialysis group. The rate of thyroid enlargement in HD group was significantly higher than that in normal group. 2. The abnormal rate of thyroid structure and the incidence of thyroid nodule in HD group were significantly higher than those in normal group. 2. The incidence of multiple thyroid nodules in HD group was significantly higher than that in CAPD group. The incidence of solid thyroid nodules in HD group and CAPD group was significantly higher than that in normal group. The incidence of thyroid cyst and solid mixed nodule in non-dialysis group was significantly higher than that in normal group, and the abnormal rate of thyroid function in non-dialysis group was significantly higher than that in non-dialysis group. The incidence of low T3 syndrome in HD group was significantly higher than that in normal group. The levels of TT3 / FT3 in the non-dialysis group were significantly lower than those in the normal group. The thyroid nodules in patients with end-stage nephropathy were more likely to appear in women and older patients. Conclusion: 1. Compared with normal people, thyroid nodules in patients with end-stage nephropathy are more likely to occur in women and older patients. Patients with end-stage nephropathy are prone to abnormal structure and function of thyroid. 2. There is no significant difference in the improvement of thyroid structure and function in patients with end-stage nephropathy by different dialysis methods. 3. High-frequency ultrasound can be used to objectively evaluate the end of the disease. Changes of thyroid structure in patients with Nephropathy, Combined with thyroid function can provide comprehensive information of thyroid abnormalities in patients with end-stage nephropathy and provide evidence for clinical treatment and prognosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R445.1

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