Lin Chih Ching, Yang Wu Chang, Ng Yee Yung, Chou Yi Hong, Tarng Der Cherng, Chen Tzen Wen
Department of Medicine, Veterans General Hospital-Taipei, and School of Medicine, National Yang-Ming University, Taiwan, Republic of China.
Perit Dial Int. 2002 May-Jun;22(3):394-9.
To investigate the association of clinical parameters and serum anion gap with thyroid dysfunction and nodular goiter in continuous ambulatory peritoneal dialysis (CAPD) patients.
Cross-sectional study.
Single dialysis unit and outpatient clinic.
This study Included 89 uremic patients on CAPD. Gender ratio was 50 males to 39 females (M/F = 1.28); mean age was 54.8 years.
We investigated the prevalence of nodular goiter and thyroid dysfunction with a 10-MHz high-frequency ultrasound scanner and immunoassay kits.
Nodular goiter was detected in 52.8% (47/89) of the CAPD patients. Patients with nodular goiter were older than those without goiter (57.7 vs 51.5 years, p < 0.05). Nodular goiter was found more frequently in females than in males (66.7% vs 44.0%, p < 0.05). Patients with nodular goiter had longer duration of CAPD than patients without goiter (51.6 +/- 42.9 vs 31.0 +/- 28.1 months, p < 0.02). In addition, CAPD patients with goiter had a higher serum anion gap (AG) (16.8 +/- 3.3 vs 14.0 +/- 4.5 mEq/L, p < 0.02) and a lower weekly creatinine clearance (55.9 +/- 12.6 vs 64.6 +/- 21.1 L/week/1.73 m2, p < 0.05) than patients without goiter. As serum AG gradually Increased, significant alteration of thyroid parameters developed In the following sequence: (1) reduction of total T3 level at an AG level of 15, (2) elevation of thyrotropin (TSH) and Increased prevalence of goiter at an AG of 18, and (3) reduction of free T4 and total T4 levels and elevation of TSH, with further increased frequency of goiter at an AG of 20 mEq/L.
According to this study, age, gender, dialysis duration, serum AG, and weekly creatinine clearance are correlated with prevalence of goiter in CAPD patients. Sequential alteration of thyroid function and Increasing frequency of nodular goiter correlated with higher serum AG. There are two explanations for this correlation: the level of serum AG may be an indirect index of the level of serum goitrogens, and higher serum AG and Increased frequency of nodular goiters might be a reflection of loss of residual renal function. Therefore, thyroid function screening and goiter detection using ultrasound should be considered when examining CAPD patients with progressively elevating serum anion gap.
探讨持续非卧床腹膜透析（CAPD）患者的临床参数及血清阴离子间隙与甲状腺功能障碍和结节性甲状腺肿的相关性。
横断面研究。
单一透析单元及门诊。
本研究纳入89例接受CAPD治疗的尿毒症患者。男女比例为50例男性对39例女性（男/女 = 1.28）；平均年龄为54.8岁。
我们使用10兆赫高频超声扫描仪和免疫分析试剂盒调查结节性甲状腺肿和甲状腺功能障碍的患病率。
89例CAPD患者中，52.8%（47/89）检测出结节性甲状腺肿。有结节性甲状腺肿的患者比无甲状腺肿的患者年龄更大（57.7岁对51.5岁，p < 0.05）。女性结节性甲状腺肿的发生率高于男性（66.7%对44.0%，p < 0.05）。有结节性甲状腺肿的患者CAPD治疗时间比无甲状腺肿的患者更长（51.6±42.9对31.0±28.1个月，p < 0.02）。此外，有甲状腺肿的CAPD患者血清阴离子间隙（AG）更高（16.8±3.3对14.0±4.5 mEq/L，p < 0.02），每周肌酐清除率更低（55.9±12.6对64.6±21.1 L/周/1.73 m²，p < 0.05）。随着血清AG逐渐升高，甲状腺参数出现显著变化，顺序如下：（1）AG水平为15时总T3水平降低；（2）AG为18时促甲状腺激素（TSH）升高且甲状腺肿患病率增加；（3）AG为20 mEq/L时游离T4和总T4水平降低，TSH升高，甲状腺肿发生率进一步增加。
根据本研究，年龄、性别、透析时间、血清AG和每周肌酐清除率与CAPD患者甲状腺肿的患病率相关。甲状腺功能的顺序变化及结节性甲状腺肿发生率增加与更高的血清AG相关。对此相关性有两种解释：血清AG水平可能是血清致甲状腺肿物质水平的间接指标，血清AG升高和结节性甲状腺肿发生率增加可能反映残余肾功能丧失。因此，在检查血清阴离子间隙逐渐升高的CAPD患者时，应考虑使用超声进行甲状腺功能筛查和甲状腺肿检测。
