甲状腺激素对慢性肾脏病合并亚临床甲减患者营养状况的研究

发布时间：2018-06-08 19:12

本文选题：慢性肾脏病 + 甲状腺功能减退症　；参考：《泰山医学院》2014年硕士论文

【摘要】：目的：本文的研究目的是进一步明确在甲状腺与肾脏疾病之间的相关性；对慢性肾脏病3-4期患者在合并原发性亚临床甲状腺功能减退的情况下，就营养不良的发病情况进行现状分析；及应用左旋甲状腺激素治疗亚临床甲减，能否在一定程度上改善慢性肾脏病患者营养状况及延缓肾脏疾病进展。方法：根据估算的肾小球率过滤eGFR，共纳入190例CKD3-4期患者，其中CKD3期组（n=90），CKD4期组（n=100），收集患者入院时的年龄、性别、体重、身高、血生化检查、甲状腺功能等免疫指标，尽可能详细的询问患者既往病史、肾脏病的原发病、长期口服药史、过敏史等情况，对两组患者的蛋白质能量摄入情况；生化参数指标：血白蛋白、前白蛋白、肌酐指数等；人体测量：体重指数；功能状态：左右手握力；主观综合性营养评估：SGA评分，通过主观及客观营养状况评估指标进行对照分析。再将每组患者根据外周血抽取的甲状腺功能检测结果分为以下两个组：A组TSH在数值上测得在正常范围之内，定义为非亚临床甲状腺功能减退组。B组TSH在数值上高于正常范围，FT3、FT4在数值上无明显异常，定义为亚临床甲状腺功能减退组。再将根据甲状腺功能入选的3-4期慢性肾脏病患者分为对照组a组（n=135）和实验组b组（n=55），其中CKD3期组分为a3（n=65）和b3(n=25)，CKD4组分为a4(n=70)和b4(n=30)。实验组最初给予25μg/d口服左旋甲状腺激素替代治疗，后根据病情进展情况对应用剂量进行调整，每个月检测1次血清TSH浓度变化，同时检测T3及T4的变化情况。当TSH浓度降至正常范围后，上述指标的检测改为每3个月1次，随访时间为18个月。对以上所采集资料，应用统计学软件SPSS13.0进行统计学处理，并分析其临床意义。结果：（1）在排除其他干扰因素的提前下（如身高、性别、年龄等）；对CKD3期与CKD4期甲状腺替代后的TSH变化，做完全独立样本t检验，P值0.05，不具有显著差异。（2）应用甲状腺激素治疗甲状腺功能减退前后，对慢性肾脏病的eGFR做完全独立样本t检验，P值0.0.5，具有显著差异。且CKD3b组较CKD4b组变化明显。（3）非亚临床甲减组与亚临床甲减组治疗前营养评估比较如下：血浆白蛋白水平（30.98±3.68g/L vs28.92±5.27g/L，P㩳0.05）、血红蛋白水平（113.58±18.33g/Lvs99.76±17.66g/L，P=0.001）、左手（182.80±84.71N vs142.5±61.64N，P㩳0.05）及右手握力（199.60±82.18N1VS162.82±69.05N，P㩳0.05）均明显降低，具有统计学意义。（4）经左旋甲状腺激素替代治疗慢性肾脏病合并亚临床甲状腺功能减退上后各相关营养指标变化，，血浆白蛋白水平（29.87±4.72g/L vs28.93±5.29g/L， P㩳0.05）、血红蛋白水平（103.53±13.75g/L vs99.77±17.67g/L， P=0.001）、左手（152.87.00±35.58N vs143.5±61.65N，P㩳0.05）及右手握力（178.70±47.45N1VS162.83±69.07N，P㩳0.05），上述指标均较替代治疗前相对提高，进行独立样本检验，具有显著统计学意义。结论：（1）经左旋甲状腺激素治疗亚临床甲状腺功能减退患者前后，CKD3组与CKD4组甲状腺功能均恢复至正常范围，且甲状腺恢复程度无显著差异。（2）CKD3-4期亚临床甲减患者经甲状腺激素治疗，eGFR改善较治疗前均有显著差异，其中CKD3组较CKD4组改善明显。（3）亚临床甲状腺功能减退组的营养评标指标血清白蛋白、血红蛋白、双手握力及SGA评分与非亚临床减退组相比较，数值均下降，甲状腺机能减退可影响慢性肾脏病患者的营养状态。（4）经左旋甲状腺激素替代治疗慢性肾脏病3-4期合并亚临床甲状腺功能减退患者，各营养学指标均较治疗前有所提升。表明由亚临床甲减因其的慢性肾脏病营养不良状态，经甲状腺激素替代治疗后可部分恢复。为临床医师选择治疗时机提供依据。
[Abstract]:Purpose :

The aim of this study is to further clarify the correlation between thyroid and kidney disease .
In the cases of chronic renal disease 3 - 4 , the incidence of malnutrition was analyzed in patients with primary subclinical hypothyroidism .
and can improve the nutritional status of patients with chronic kidney disease and delay the progression of kidney disease to a certain extent .

Method :

According to the estimated glomerular filtration rate , 190 patients with CKD3 - 4 were enrolled , including CKD3 ( n = 90 ) , CKD4 ( n = 100 ) , age , sex , weight , height , blood biochemical examination , thyroid function , etc .
Biochemical parameters : serum albumin , prealbumin , creatinine index , etc . ;
Human Body Measurement : Body Mass Index ;
Function state : left - hand grip ;
The results were as follows : Group A ( n = 65 ) and group B ( n = 30 ) . The serum TSH concentration in group B was significantly higher than that of normal range , and was defined as subclinical hypothyroidism . After the concentration of TSH decreased to normal range , the changes of serum TSH in group B were determined . The results were as follows : After the concentration of TSH decreased to normal range , the test was performed every 3 months and the follow - up time was 18 months .

Results :

( 1 ) In advance of excluding other interference factors ( such as height , sex , age , etc . ) ;
There was no significant difference between CKD3 and CKD4 thyroid replacement after thyroid replacement ( P < 0.05 ) .

( 2 ) Before and after the treatment of hypothyroidism with thyroid hormone , a completely independent sample of t - test was performed on the patients with chronic renal disease . The value of P - value was 0 . 0 . 5 , which was significantly different . The CKD3b group was more obvious than CKD4b group .

( 3 ) The pre - treatment nutritional assessment of non - subclinical hypothyroidism group and sub - clinical hypothyroidism group were as follows : plasma albumin level ( 30.98 卤 3.68g / L vs 28.92 卤 5.27g / L , P ? 0.05 ) , hemoglobin level ( 13.58 卤 18.33g / Lvs99.76 卤 17.66g / L , P = 0.001 ) , left hand ( 182.80 卤 84.71 N vs 142.5 卤 61.64N , P ? 0.05 ) and right hand grip ( 199.60 卤 82.18N1VS162.82 卤 69.05N , P ? 0.05 ) .

( 4 ) After the treatment of chronic renal disease with levorotatory thyroid hormone replacement , the serum albumin level ( 29.87 卤 4.72g / L vs 28.93 卤 5.29g / L , P ? 0.05 ) , hemoglobin level ( 103.53 卤 13.75g / L vs 99.77 卤 17.67g / L , P ? 0.05 ) and right hand grip ( 178.70 卤 47.45N1VS162.83 卤 69.07N , P ? 0.05 ) .

Conclusion :

( 1 ) The thyroid function of CKD3 group and CKD4 group were recovered to the normal range before and after the treatment of subclinical hypothyroidism with L - thyroid hormone , and there was no significant difference in the degree of thyroid recovery .

( 2 ) There was a significant difference between CKD3 - 4 and CKD4 group .

( 3 ) The serum albumin , hemoglobin , both hands grip and SGA score of subclinical hypothyroidism group were compared with those of non - subclinical hypothyroidism group , and the values decreased , and hypothyroidism could influence the nutritional status of patients with chronic kidney disease .

( 4 ) After the treatment of chronic renal disease 3 - 4 with levorotatory thyroid hormone replacement therapy , all the nutritional indexes were improved before treatment . It was suggested that subclinical hypothyroidism could be partially recovered after treatment with thyroid hormone replacement therapy . It provided the basis for clinicians to choose the treatment time .
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692;R581.2

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