慢性肾脏病（CKD-5期）患者微炎症状态与甲状腺功能的相关性研究

发布时间：2019-02-14 21:15

【摘要】：目的：探讨慢性肾脏病（CKD-5期）患者微炎症状态与甲状腺功能的相关性。通过本实验测定CKD-5期患者甲状腺激素的水平及其与机体微炎症状况相关指标的相关性研究，评估尿毒症微炎症状态对甲状腺功能的影响。方法：选择2013年1月-2014年1月在青海大学附属医院肾脏内科治疗的慢性肾脏(CKD-5期)患者60例作为实验组，分为透析组和非透析组，每组各30例。入选者均符合2002年美国K/DOQI关于CKD定义及分期标准，血液透析患者透析时间介于6个月到2年之间，所选患者近期均无肺部近期感染病史、无原发性甲状腺疾病、无恶性肿瘤病史，一般情况可。另再选取年龄及性别与实验组匹配的青海大学附属医院体检中心健康体检者30例作为对照组，且均无心肺疾病，肝肾功能正常。各组的年龄、性别构成相比较，差别无统计学意义，具有可比性。应用SPSS17.0软件包进行统计分析，计量资料以x士s表示，不同组别之间采用单因素方差分析，相关性采用直线相关分析，检验标准a=0.05,以P＜0.05为有统计学意义。结果：1、实验组与对照组血清甲状腺激素、ALB、CRP比较（P＜0.05），差别有统计学意义，提示实验组的血清甲状腺激素水平、血清ALB水平均低于对照组，血清CRP水平均高于对照组；透析组与非透析组比较（P＜0.05），差别有统计学意义。2、实验组相关指标的相关分析：血清甲状腺激素与ALB呈正相关（P＜0.05），，与血清CRP呈负相关（P＜0.05）。结论：1、在终末期肾病患者中，甲状腺激素水平、血清ALB水平相对于健康人明显降低，血清CRP水平相对于健康人明显升高，而透析后患者的甲状腺激素水平、血清ALB水平相对于非透析患者明显升高，血清CRP水平相对于非透析患者明显降低，以上可提示在终末期肾病患者中存在着非甲状腺疾病引起的甲状腺功能改变及微炎症症状，且合并白蛋白低下，而患者在接受透析治疗后上述症状比非透析时明显减轻。透析后患者的一般状况得到改善的原因可能与水负荷的减轻、炎症因子的有效清除、毒素的清除等有关。因此，当慢性肾脏病患者发展到终末期时，该研究可以为我们及早采取血液透析干预治疗措施减少以上并发症的发生提供一定的临床参考，进一步可减少因机体甲状腺功能改变可能带来的相关并发症的发生。2、在终末期肾病患者中，血清甲状腺激素与血清CRP呈负相关，与血清ALB呈正相关，可提示患者的甲功改变与微炎症状态的严重程度有一定的关系，因此，可为透析人群积极采取临床干预措施，如应用生物相容性高的透析膜等降低微炎症状态的发生或补充白蛋白等，进而防止甲功改变可能会导致的甲状腺激素减少进一步引起相关症状的发生及加重提供相关依据。
[Abstract]:Objective: to investigate the correlation between microinflammation and thyroid function in patients with chronic kidney disease (CKD-5). In order to evaluate the effect of uremic microinflammation on thyroid function, the level of thyroid hormone and the correlation between thyroid hormone levels and microinflammation in patients with CKD-5 were studied in this study. Methods: from January 2013 to January 2014, 60 patients with chronic kidney (CKD-5) treated in Department of Renal Medicine, affiliated Hospital of Qinghai University, were divided into two groups: dialysis group (n = 30) and non-dialysis group (n = 30). All the selected patients were in accordance with the definition and staging of CKD by K/DOQI in 2002. The duration of hemodialysis was between 6 months and 2 years. The selected patients had no recent history of pulmonary infection and no primary thyroid disease. No history of malignant tumor, general situation can. In addition, 30 healthy persons in the physical examination center of Qinghai University affiliated Hospital matched with the experimental group were selected as the control group, and all of them had no heart lung disease and normal liver and kidney function. The age and sex composition of each group had no statistical significance and was comparable. The statistical analysis was carried out by using SPSS17.0 software package. The measurement data were expressed as x + s, single factor analysis of variance and linear correlation analysis were adopted among different groups. The test standard a0.05 was statistically significant (P < 0. 05). Results: 1. There were significant differences in serum thyroid hormone and ALB,CRP between the experimental group and the control group (P < 0. 05), which indicated that the serum thyroid hormone level and serum ALB level in the experimental group were lower than those in the control group. The level of serum CRP was higher than that of control group. There was significant difference between dialysis group and non-dialysis group (P < 0. 05). 2. Correlation analysis of serum thyroid hormone and ALB in experimental group was positive (P < 0. 05). There was a negative correlation with serum CRP (P < 0. 05). Conclusions: 1. The levels of thyroid hormone, serum ALB and serum CRP in patients with end-stage nephropathy were significantly lower than those in healthy subjects, while the levels of thyroid hormones in dialysis patients were significantly higher than those in healthy subjects. Serum ALB level was significantly higher than that in non-dialysis patients, and serum CRP level was significantly lower than that in non-dialysis patients. These results suggest that there are thyroid functional changes and microinflammatory symptoms caused by non-thyroid diseases in patients with end-stage nephropathy. These symptoms were significantly alleviated after dialysis treatment than in non-dialysis patients. The improvement of general condition after dialysis may be related to the reduction of water load, the effective clearance of inflammatory factors, and the clearance of toxins. Therefore, when the patients with chronic kidney disease develop to the end stage, this study can provide a certain clinical reference for us to take early intervention measures of hemodialysis to reduce the occurrence of the above complications. In patients with end-stage nephropathy, serum thyroid hormone was negatively correlated with serum CRP, and positively correlated with serum ALB. It can be concluded that the changes of thyroid function of the patients are related to the severity of microinflammation, therefore, the clinical intervention measures can be taken actively for the dialysis population. For example, the application of highly biocompatible dialysis membrane can reduce the occurrence of microinflammation or supplement albumin, so as to prevent the decrease of thyroid hormone which may lead to the decrease of thyroid hormone, which may lead to the occurrence and aggravation of related symptoms.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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