Prado-Uribe María Del Carmen, Ventura María-de-Jesús, Ávila-Díaz Marcela, Mora Carmen J, Méndez-Durán Antonio, Villanueva-Noches Diana, Cisneros Alejandra, Ilabaca Begoña, Cueto-Manzano Alfonso, García-Contreras Fernando, Lindholm Bengt, García-López Elvia, Paniagua Ramón
Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México.
Hospital General Regional 25, IMSS, Ciudad de México, México.
Nefrologia. 2017 Nov-Dec;37(6):598-607. doi: 10.1016/j.nefro.2017.05.015. Epub 2017 Jul 26.
Low thyroid hormone (TH) levels and myocardial damage are common in dialysis patients and are associated with mortality. However, little is known about the role of THs on myocardial damage as has been described in primary thyroid diseases. The aim of this study was to explore the potential relationship between low total triiodothyronine (total T3) and biomarkers of myocardial damage and the effect of their interaction on mortality, to ascertain if cardiovascular damage is the link between low THs and the risk of death in dialysis patients with CKD.
TH plasma levels, nutritional markers, inflammation and myocardial damage were studied in 296 patients undergoing peritoneal dialysis or haemodialysis, who were followed up for 16 months to ascertain the association between biochemical variables and mortality.
Low total T3 levels were found in 45% of patients, which was inversely correlated with C-reactive protein (CRP) and NT-proBNP, and directly correlated with albumin and transferrin. Diabetes, CRP and total T3 were risk factors for all-cause mortality, and CRP, NT-proBNP and total T3 for cardiovascular mortality.
Low total T3 levels are common in dialysis patients and are associated with inflammation, malnutrition and myocardial damage. The latter may be the link between low THs and all-cause and cardiovascular mortality.
甲状腺激素（TH）水平低下和心肌损伤在透析患者中很常见，且与死亡率相关。然而，关于TH在心肌损伤中的作用，如同在原发性甲状腺疾病中所描述的那样，人们了解甚少。本研究的目的是探讨低总三碘甲状腺原氨酸（总T3）与心肌损伤生物标志物之间的潜在关系，以及它们的相互作用对死亡率的影响，以确定心血管损伤是否是慢性肾脏病透析患者低TH水平与死亡风险之间的联系。
对296例接受腹膜透析或血液透析的患者进行了TH血浆水平、营养指标、炎症和心肌损伤的研究，并对其进行了16个月的随访，以确定生化变量与死亡率之间的关联。
45%的患者总T3水平较低，其与C反应蛋白（CRP）和N末端脑钠肽前体（NT-proBNP）呈负相关，与白蛋白和转铁蛋白呈正相关。糖尿病、CRP和总T3是全因死亡率的危险因素，CRP、NT-proBNP和总T3是心血管死亡率的危险因素。
透析患者中总T3水平较低很常见，且与炎症、营养不良和心肌损伤相关。后者可能是低TH水平与全因死亡率和心血管死亡率之间的联系。
