原发性肾病综合征患者甲状腺功能变化与其尿蛋白水平及病理关系探讨

发布时间：2018-03-02 23:03

  本文选题：原发性肾病综合征　切入点：甲状腺激素　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨原发性肾病综合征患者甲状腺功能变化与其尿蛋白水平及病理关系。 方法回顾性分析厦门大学附属中山医院肾内科收治的82例原发性肾病综合征（Primary Nephrotic Syndrome，PNS）患者（PNS组），排除既往有甲状腺相关疾病史患者，根据甲状腺激素水平分为甲状腺功能正常组（NG组）、甲状腺功能异常组（AG组），选20例我院正常体检者为对照组(CG组)，比较PNS组与CG组间的甲状腺激素水平；比较NG组与AG组患者血清白蛋白、血脂、肌酐、尿素氮、尿微量白蛋白等水平及与甲状腺功能的相关性，观察各肾脏病理类型与甲状腺功能的关系。 结果①82例PNS患者中甲状腺功能正常20例，甲状腺功能异常62例，其中甲状腺功能减退症10例，，甲状腺功能亢进症2例，非甲状腺性的病态综合征49例，桥本甲状腺炎1例。PNS组与CG组比较，FT3、FT4显著降低（FT3：3.22±1.55pmol/l VS4.44±0.93pmol/l，FT4：13.08±3.51pmol/l VS19.20±2.77pmol/l），TSH显著升高（4.09±4.11uIU/l VS2.48±1.06uIU/l），差异均有统计学意义（均p＜0.05）。②AG组与NG组比较，血清白蛋白更低（18.28±5.31g/l VS22.87±3.61g/l，p＜0.05)，而尿微白蛋白更高（8873.52±6990.76mg/l VS3167.8±1629.66mg/l，p＜0.05）。③AG组FT3、FT4与血清白蛋白呈正相关（FT3：r=0.301，p＜0.05；FT4：r=0.311，p＜0.05）；FT4与尿微白蛋白呈负相关(r=-0.282，p＜0.05)， FT3与尿微量白蛋白相关性不明显（r=-0.177，p＞0.05）；而THS与血清白蛋白呈负相关、与尿微量白蛋白呈正相关（均p＜0.05），TH与血脂则无相关性(均p＞0.05)。④NG组与AG组不同肾脏病理类型构成比无明显差异（χ2=2.223, p=0.695＞0.05）。 结论①PNS患者临床上易合并甲状腺功能异常，主要表现为非甲状腺疾病综合征，检测甲状腺功能可以协助评估病情。②PNS患者出现甲状腺功能异常既可能是病态情况下机体的一种保护性机制，还可能与摄取原料减少、低蛋白血症、药物作用、免疫损伤的因素有关。③FT3、FT4与血清白蛋白呈正相关，与尿微量白蛋白呈负相关，尚不能认为PNS患者出现甲状腺功能异常与肾脏病理类型有关。
[Abstract]:Objective to investigate the relationship between thyroid function and urinary protein level in patients with primary nephrotic syndrome. Methods A retrospective analysis of 82 patients with primary Nephrotic Syndrome PNS was performed in the Department of Renal Medicine, Zhongshan Hospital affiliated to Xiamen University, and the history of thyroid related diseases was excluded. According to the thyroid hormone level, the thyroid hormones were divided into two groups: normal thyroid function group (NG group) and abnormal thyroid function group (AG group). Twenty healthy persons in our hospital were selected as control group (CG group). The thyroid hormone levels between PNS group and CG group were compared. The relationship between serum albumin, serum lipid, creatinine, urea nitrogen, urinary microalbumin and thyroid function was compared between NG group and AG group. Results there were 20 cases of normal thyroid function and 62 cases of abnormal thyroid function, including 10 cases of hypothyroidism, 2 cases of hyperthyroidism and 49 cases of non-thyroid morbid syndrome. One case with Hashimoto's thyroiditis. Compared with CG group, FT3T4 significantly decreased FT3: 3.22 卤1.55pmol / L VS4.44 卤0.93pmol / L VS4.44 卤0.93pmol / L FT4: 13.08 卤3.51pmol / L VS19.20 卤2.77pmol / L TSH significantly increased 4.09 卤4.11uIUmol / L VS2.48 卤1.06uIUP / L respectively (P < 0.05.2AG vs NG). Serum albumin was lower (18.28 卤5.31 g / l VS22.87 卤3.61 g / L P < 0.05), while urinary microalbumin was higher than 8873.52 卤6990.76 mg / L VS3167.8 卤1629.66 mg / L P < 0.05 g / L P < 0.05 mg / L P < 0.05 mg / L 路3AG group (P < 0.05). The correlation between THS and serum albumin was positively correlated with FT _ 3rU _ (0.301) VS22.87 < 0.311p < 0.05 渭 r = 0.311p < 0.05 渭 g / ml. FT3 had no significant negative correlation with urinary microalbumin (r-0.177p > 0.05g / g / g / g / g / g / g / g / g / g / g / 3AG group), but there was a negative correlation between THS and serum albumin (r = -0.177p > 0.05g / g / g / g / g / g / g / g / 3AG / g / g / g / g / g / g / g / g / 3AG group), while a negative correlation between THS and serum albumin was observed. There was no significant correlation between TH and serum lipids (P > 0.05). There was no significant difference in the ratio of different renal pathological types between AG group and AG group (蠂 ~ 2 = 2.223, p ~ 0.695 > 0.05). Conclusion (1) the patients with PNS are easily complicated with abnormal thyroid function, which is mainly characterized by non-thyroid disease syndrome. Detection of thyroid function may assist in assessing thyroid dysfunction in patients with PNS, which may be a protective mechanism of the body under pathological conditions, and may be associated with reduced intake of raw materials, hypoproteinemia, and drug effects. The factors related to immune injury were positively correlated with serum albumin and negatively correlated with urinary microalbumin. The abnormal thyroid function in patients with PNS was not related to the pathological type of kidney.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692


本文编号：1558465