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慢性血液透析患者的低T3综合征与长期死亡率

Low T3 syndrome and long-term mortality in chronic hemodialysis patients.

作者信息

Fragidis Stylianos, Sombolos Konstantinos, Thodis Elias, Panagoutsos Stylianos, Mourvati Euthymia, Pikilidou Maria, Papagianni Aikaterini, Pasadakis Ploumis, Vargemezis Vasilios

机构信息

Stylianos Fragidis, Elias Thodis, Stylianos Panagoutsos, Euthymia Mourvati, Ploumis Pasadakis, Vasilios Vargemezis, Department of Nephrology, Medical School, Democritus University of Thrace, 68100 Alexadroupolis, Greece.

出版信息

World J Nephrol. 2015 Jul 6;4(3):415-22. doi: 10.5527/wjn.v4.i3.415.

Abstract

AIM

To investigate the predictive value of low freeT3 for long-term mortality in chronic hemodialysis (HD) patients and explore a possible causative role of chronic inflammation.

METHODS

One hundred fourteen HD patients (84 males) consecutively entered the study and were assessed for thyroid function and two established markers of inflammation, high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Monthly blood samples were obtained from all patients for three consecutive months during the observation period for evaluation of thyroid function and measurement of inflammatory markers. The patients were then divided in two groups based on the cut-off value of 1.8 pg/mL for mean plasma freeT3, and were prospectively studied for a mean of 50.3 ± 30.8 mo regarding cumulative survival. The prognostic power of low serum fT3 levels for mortality was assessed using the Kaplan-Meier method and univariate and multivariate regression analysis.

RESULTS

Kaplan-Meier survival curve showed a negative predictive power for low freeT3. In Cox regression analysis low freeT3 remained a significant predictor of mortality after adjustment for age, diabetes mellitus, hypertension, hsCRP, serum creatinine and albumin. Regarding the possible association with inflammation, freeT3 was correlated with hsCRP, but not IL-6, and only at the first month of the study.

CONCLUSION

In chronic hemodialysis patients, low plasma freeT3 is a significant predictor of all-cause mortality. Further studies are required to identify the underlying mechanisms of this association.

摘要

目的

探讨低游离T3对慢性血液透析(HD)患者长期死亡率的预测价值,并探讨慢性炎症可能的致病作用。

方法

114例HD患者(84例男性)连续纳入研究,评估甲状腺功能以及两种既定的炎症标志物,即高敏C反应蛋白(hsCRP)和白细胞介素-6(IL-6)。在观察期内,连续三个月每月采集所有患者的血样,以评估甲状腺功能并测量炎症标志物。然后根据平均血浆游离T3的临界值1.8 pg/mL将患者分为两组,并对累积生存率进行了平均50.3±30.8个月的前瞻性研究。采用Kaplan-Meier法以及单因素和多因素回归分析评估低血清fT3水平对死亡率的预后能力。

结果

Kaplan-Meier生存曲线显示低游离T3具有负向预测能力。在Cox回归分析中,调整年龄、糖尿病、高血压、hsCRP、血清肌酐和白蛋白后,低游离T3仍然是死亡率的重要预测指标。关于与炎症的可能关联,游离T3仅在研究的第一个月与hsCRP相关,而与IL-6无关。

结论

在慢性血液透析患者中,低血浆游离T3是全因死亡率的重要预测指标。需要进一步研究以确定这种关联的潜在机制。

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