Fernández-Reyes M J, Sánchez R, Heras M, Tajada P, Iglesias P, García L, García Arévalo M C, Molina A, Rodríguez A, Alvarez-Ude F
Servicio de Nefrología, Hospital General de Segovia, Segovia.
Nefrologia. 2009;29(4):304-10. doi: 10.3265/Nefrologia.2009.29.4.5162.en.full.
Low serum free triiodothyronine (FT3) levels have been reported in a high percentage of chronic renal failure (CRF) patients and have been considered as independent predictors of mortality in both hemodialysis (HD) and peritoneal dialysis (PD). A reduction in thyroid function in dialysis patients could be a marker of malnutrition and/or inflammation.
Our aim has been to evaluate the incidence of low T3 syndrome in a group of dialysis patients and analyze its relationship with different parameters of malnutrition and inflammation. PATIENTS AND METHODS We included 32 stable dialysis patients (24 HD and 8 DP); mean age +/- SD 71.2 +/- 11.7 years; 46.9% males; 15.6% diabetics; mean time on dialysis 47 +/- 43 months. The following parameters were measured in every patient: thyrothropin (TSH), Free T4 (FT4) and Free T3 (FT3); biochemical data related to nutritional status; anthropometric measurements, bioelectrical impedance vector analysis (BIVA), and dietary survey of three consecutive days. Statistical analysis was performed by using SPSS 11.0.
Mean hormonal values of thyroid function were: TSH 2,2 +/- 1.5 U/ml (range: 0,4-5.0); FT4 14.7 +/- 2.3 pmol/l (range: 11.0-23.0) and FT3 4,0 +/- 0.71 pmol/l (range: 3.95-6.80). Only 2 patients (6.3%) showed low FT4 levels and another 2 patients increased TSH levels, whereas 17 patients (53.1%) presented with low FT3 levels. We did not found any correlation between serum FT3, FT4 and TSH levels. We found a correlation between FT3 and inflammation/nutritional parameters: prealbumin (r = 0,36; p = 0,04); transferrin (r = 0,40; p = 0,025); PCR (r = -0.38; p = 0,039); and IGF-I (r = 0,38; p = 0,03); body mass index (BMI) (r = 0,51; p = 0,002); arm circumference (AC) (r = 0,65; p = 0,000), and arm muscle circumference (AMC) (r = 0,72; p = 0,000). FT3 levels were also correlated with BIVA parameters: phase angle (r = 0,54; p = 0,002); muscle mass percentage (r = 0,49; p = 0,005); and cell mass percentage (r = 0,53; p = 0,02), but not with any data of fat mass. AMC was the only variable that independently correlated with FT3 levels in the multivariate regression analysis (r = 0,69; r2: 0,48; p = 0,000)
Half of our dialysis patients have decreased levels of serum FT3 without alteration on FT4 or TSH. Low FT3 levels are correlated bioquimical and anthropometric parameters indicators of malnutrition and inflammation. Periodical measurement of FT3 levels could be used by clinicians as an accesible and reproducible method to detect such states.
据报道，高比例的慢性肾衰竭（CRF）患者血清游离三碘甲状腺原氨酸（FT3）水平较低，并且被认为是血液透析（HD）和腹膜透析（PD）患者死亡率的独立预测指标。透析患者甲状腺功能减退可能是营养不良和/或炎症的标志。
我们的目的是评估一组透析患者中低T3综合征的发生率，并分析其与营养不良和炎症的不同参数之间的关系。患者与方法 我们纳入了32例稳定的透析患者（24例HD患者和8例DP患者）；平均年龄±标准差为71.2±11.7岁；男性占46.9%；糖尿病患者占15.6%；平均透析时间为47±43个月。对每位患者测量以下参数：促甲状腺激素（TSH）、游离T4（FT4）和游离T3（FT3）；与营养状况相关的生化数据；人体测量、生物电阻抗矢量分析（BIVA）以及连续三天的饮食调查。使用SPSS 11.0进行统计分析。
甲状腺功能的平均激素值为：TSH 2.2±1.5 U/ml（范围：0.4 - 5.0）；FT4 14.7±2.3 pmol/l（范围：11.0 - 23.0），FT3 4.0±0.71 pmol/l（范围：3.95 - 6.80）。只有2例患者（6.3%）FT4水平较低，另外2例患者TSH水平升高，而17例患者（53.1%）FT3水平较低。我们未发现血清FT3、FT4和TSH水平之间存在任何相关性。我们发现FT3与炎症/营养参数之间存在相关性：前白蛋白（r = 0.36；p = 0.04）；转铁蛋白（r = 0.40；p = 0.025）；PCR（r = -0.38；p = 0.039）；以及IGF - I（r = 0.38；p = 0.03）；体重指数（BMI）（r = 0.51；p = 0.002）；上臂围（AC）（r = 0.65；p = 0.000），以及上臂肌肉围（AMC）（r = 0.7
