原发性肾病综合征甲状腺激素水平及病理分析

发布时间：2018-03-01 10:13

本文关键词： 原发性肾病综合征甲状腺激素甲状腺病态综合征尿蛋白　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过分析原发性肾病综合征患者血清甲状腺激素水平变化与病理类型的关系,深入了解原发性肾病综合征与甲状腺激素水平之间的关系,进一步指导临床原发性肾病综合征的治疗。方法:收集2015年2月至2016年12月期间在我科(皖南医学院弋矶山医院肾内科)住院,确诊为原发性肾病综合征的且既往无甲状腺相关病史及继发性肾病综合征的75例患者的资料,该75例患者设为观察组(PNS组),其中甲状腺功能正常35例(A组),甲状腺功能异常40例(B组),并选择同期在我院健康体检的75例人员作为对照组(C组)。比较对照组(C组)与PNS组(A组、B组)甲状腺激素水平,并分析原发性肾病综合征(PNS组)患者血清白蛋白(ALB),血脂(TC,TG),血肌酐(Scr),尿素氮(Urea),24小时尿蛋白定量等相应生化指标与甲状腺功能的相关性以及甲状腺激素水平与其病理类型的相关性。结果:在75例原发性肾病综合征(PNS)患者中,甲状腺功能异常有40例,占53.3%(40/75),生化检查多以游离三碘甲状腺(FT3),游离甲状腺素(FT4)下降为主,可伴有促甲状腺素(TSH)升高。PNS组与对照组(C组)比较,FT3及FT4下降明显,血清TSH升高较对照组明显,差异均有显著统计学意义(P0.01)。PNS组与对照组(C组)相比,PNS组中男性患者54例,女性患者21例,分别占72%,28%;患者年龄平均(43.65±11.779)周岁;对照组中男性51名,女性24名,分别占68%,32%;年龄平均值(40.00±11.209)周岁,两组性别、年龄数据经检验均无统计学意义(P0.05),表明性别及年龄与疾病程度无关。对照组(C组)ALB较观察组(PNS组)高,其TC、TG、Scr、Urea低于观察组,且差异均具有统计学意义(P0.05)。PNS组内比较,甲状腺功能异常组(B组)FT3及FT4水平、血清白蛋白(ALB)低于甲状腺功能正常组(A组),而Scr、Urea、24小时尿蛋白定量高于甲状腺功能正常组(A组),其差异均有统计学意义(P0.05);此外,B组FT3、FT4与Scr、Urea成负相关性,FT3、FT4与血清白蛋白(ALB)呈正相关性,B组中不同程度24h尿蛋白定量与其对应FT3、FT4呈负相关性;其FT3、FT4、TSH与TG、TC无明显相关关系(P均0.05)。A组与B组不同肾脏病例类型构成比之间无显著差异(P=0.991),尚无法证明甲状腺功能异常与病理类型有相关关系。结论:1.PNS患者易伴有甲状腺功能异常,通常以正常甲状腺病态综合征为主,生化检查示:FT3及FT4降低,同时伴TSH升高。其甲状腺水平降低程度,尤其是血清FT3降低水平往往与病情严重成正相关。2.甲状腺激素水平,尤其FT3、FT4与尿蛋白呈负相关,与血清白蛋白成正相关,因此治疗PNS合并甲状腺功能异常的关键在于减少尿蛋白流出。3.积极治疗原发性肾病综合征,定期复查甲状腺功能,对于疾病预后有很大帮助。4.PNS患者行肾活检后可表现微小病变性肾病,系膜增生性肾病,膜性肾病等多种,尚无明确证据证明PNS患者甲状腺功能异常与其相应的病理类型有相关性。
[Abstract]:Objective: to study the relationship between serum thyroid hormone level and pathological type in patients with primary nephrotic syndrome (PNS). Methods: from February 2015 to December 2016, we were hospitalized in our department (Department of Renal Medicine, Yiji Shan Hospital, Southern Anhui Medical College). Data of 75 patients with primary nephrotic syndrome who had no history of thyroid associated diseases and secondary nephrotic syndrome. The 75 patients were divided into the observation group (PNS group), 35 cases of normal thyroid function in group A and 40 cases of abnormal thyroid function in group B, and 75 cases of healthy check-up in our hospital were selected as the control group C in the same period. The thyroid hormone levels in group A and group B were compared with those in group PNS. The correlation between serum albumin and thyroid function, serum albumin, serum lipid, serum creatinine, creatinine, urinary protein and thyroid function in patients with primary nephrotic syndrome (PNS group) were analyzed. The relationship between serum albumin and thyroid function, thyroid hormone level and pathological changes were also analyzed in patients with primary nephrotic syndrome (PNS group), such as serum albumin, serum lipids, serum creatinine, creatinine creatinine and urinary protein in 24 hours. Results: in 75 patients with primary nephrotic syndrome (PNS), There were 40 cases of thyroid dysfunction, accounting for 53.3% of 40 / 75%. The main biochemical examination was free triiodothyronine FT3, free thyroxine FT4, which could be accompanied by the increase of thyrotropin TSH. The decrease of FT3 and FT4 in the PNS group was significantly higher than that in the control group (C group). The increase of serum TSH was significantly higher than that of the control group (P 0.01g. PNS group and control group C). There were 54 male patients and 21 female patients in the control group, accounting for 72% of the total, the average age of the patients was 43.65 卤11.779 years old, 51 male patients in the control group, and 51 male patients in the control group, the average age of the patients was 43.65 卤11.779 years old, and the mean age of the patients was 43.65 卤11.779 years. The mean age was 40.00 卤11.209 years old. There was no significant difference in sex and age data between the two groups (P 0.05), which indicated that the sex and age were not related to the degree of disease. The ALB in control group C was higher than that in observation group (P NS), and its TCGGScrUUU was lower than that in observation group. There were significant differences in FT3 and FT4 levels in group B with abnormal thyroid function. Serum albumin (ALB4) was lower than that of normal thyroid function group (group A), while 24 hour urinary protein quantity of Scrr UreaI group was higher than that of normal thyroid function group (P 0.05). In addition, there was a negative correlation between FT3F3 FT4 and ScrUrea in group B and serum white egg. There was a positive correlation between ALB and FT3 FT4 in B group. There was no significant correlation between TSH and TGTC in FT3 / FT4 / TSH group. There was no significant difference between group A and group B (P < 0.05). There was no significant difference in the ratio of different renal types between group A and group B. there was no significant correlation between thyroid dysfunction and pathological type. Conclusion: 1.The patients with PNS are prone to be accompanied with abnormal thyroid function. Normal thyroid sick syndrome is usually the main disease. Biochemical examination showed that the ratio of FT3 and FT4 decreased and TSH increased. The decrease of thyroid gland level, especially the decrease of serum FT3 level, was positively correlated with the severity of the disease. The thyroid hormone level was found to be positively correlated with the level of thyroid hormone, and the serum FT3 level was positively correlated with the severity of the disease. In particular, FT3 FT4 is negatively correlated with urinary protein and positively correlated with serum albumin. Therefore, the key to treat PNS with thyroid dysfunction is to reduce urinary protein outflow. It is very helpful for the prognosis of the disease. 4. PNS patients can show minimal change nephropathy, Mesangial proliferative nephropathy, membranous nephropathy and so on after renal biopsy. There is no clear evidence that thyroid dysfunction in PNS patients is associated with their corresponding pathological types.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

【参考文献】