甲状腺功能减退及替代治疗对终末期肾衰竭患者甲状腺激素转化率及反三碘甲状腺原氨酸浓度的影响

The influence of hypothyroidism and substitution treatment on thyroid hormone conversion ratios and rT3 concentration in patients with end-stage renal failure.

作者信息

Dubczak Iwanna, Niemczyk Longin, Szamotulska Katarzyna, Jasik Mariusz, Rymarz Aleksandra, Bartoszewicz Zbigniew, Niemczyk Stanisław

机构信息

Department of Internal Diseases and Endocrinology, Medical University of Warsaw, Warsaw, Poland.

Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.

出版信息

Endokrynol Pol. 2019;70(2):165-171. doi: 10.5603/EP.a2018.0087. Epub 2018 Nov 27.

DOI:10.5603/EP.a2018.0087

PMID:30480752

Abstract

INTRODUCTION

The increasing number of patients with end-stage renal disease (ESRD) requires seeking new opportunities to improve their quality of life, not only because of kidney disease but also due to other disturbances, such as thyroid hormone disorders. The objective of the study was to evaluate the influence of coexisting hypothyroidism and thyroid hormone therapy in patients with ESRD on thyroid hormone conversion ratios and rT3 concentration.

MATERIAL AND METHODS

The study involved 85 patients aged 26 to 87 years, with a mean age of 59.62 ± 15.45 years. Four groups of patients were examined: G1 group - 25 persons without RF and hypothyroidism, G2 - 26 patients with ESRD treated with haemodialysis (HD), G3 - 12 patients with ESRD treated with HD and newly diagnosed hypothyroidism, and G4 - 22 HD patients with hypothyroidism treated with thyroid hormones substitution. The concentrations of TSH, T4, T3, fT4, fT3, and rT3 were measured and the fT3/fT4, T3/T4, and rT3/T4 conversion ratios and rT3/T3 ratio were calculated. Concentrations of protein, hsCRP, Hg, and blood gases were also checked; the anion gap was calculated.

RESULTS

Patients from group G1 through G2 to G3 were older (ptrend = 0.002), with lower Hb level (ptrend < 0.001), with lower pH (ptrend < 0.001), with increased anion gap (ptrend < 0.013) and CRP concentrations (ptrend < 0.001), and decreased total protein level (ptrend < 0.001). There were increased TSH values (ptrend < 0.001) and lower T4 (ptrend = 0.024), fT3 (ptrend < 0.001), T3 (ptrend < 0.001), and rT3 (ptrend = 0.008) levels. rT3/T3 ratio did not change, the rT3/T4 ratio tended to decrease (ptrend = 0.065) similarly to T3/T4 ratio (ptrend = 0.063), and the fT3/fT4 ratio also decreased (ptrend = 0.005). It seems that the treatment of thyroid disease in patients with renal failure, treated with haemodialysis, is not associated with change of rT3 and conversion factor levels.

CONCLUSIONS

The concentration of rT3 in HD patients in relation to healthy persons tends to decrease, and hypothyroidism increases this tendency in these patients. Hormone substitution treatment does not eliminate the influence of RF on inhibition of rT3 production. In patients with ESRD, hypothyroidism additionally reduces the conversion of thyroid hormones examined by fT3/fT4 and to a lesser extent T3/T4 ratios.

摘要

引言

终末期肾病（ESRD）患者数量不断增加，这就需要寻找新的机会来改善他们的生活质量，这不仅是因为肾病，还由于其他干扰因素，如甲状腺激素紊乱。本研究的目的是评估ESRD患者中并存的甲状腺功能减退症及甲状腺激素治疗对甲状腺激素转化率和反式三碘甲状腺原氨酸（rT3）浓度的影响。

材料与方法

本研究纳入了85例年龄在26至87岁之间的患者，平均年龄为59.62±15.45岁。对四组患者进行了检查：G1组 - 25名无类风湿因子（RF）和甲状腺功能减退症的患者；G2组 - 26例接受血液透析（HD）治疗的ESRD患者；G3组 - 12例接受HD治疗且新诊断为甲状腺功能减退症的ESRD患者；G4组 - 22例接受甲状腺激素替代治疗的HD甲状腺功能减退症患者。测量了促甲状腺激素（TSH）、甲状腺素（T4）、三碘甲状腺原氨酸（T3）、游离甲状腺素（fT4）、游离三碘甲状腺原氨酸（fT3）和rT3的浓度，并计算了fT3/fT4、T3/T4、rT3/T4转化率以及rT3/T3比值。还检查了蛋白质、超敏C反应蛋白（hsCRP）、血红蛋白（Hg）和血气浓度；计算了阴离子间隙。

结果

从G1组到G2组再到G3组的患者年龄更大（ptrend = 0.002），血红蛋白水平更低（ptrend < 0.001），pH值更低（ptrend < 0.001），阴离子间隙增加（ptrend < 0.013），C反应蛋白浓度增加（ptrend < 0.001），总蛋白水平降低（ptrend < 0.001）。TSH值升高（ptrend < 0.001），而T4（ptrend = 0.024）、fT3（ptrend < 0.001）、T3（ptrend < 0.001）和rT3（ptrend = 0.008）水平降低。rT3/T3比值没有变化，rT3/T4比值与T3/T4比值类似，有下降趋势（ptrend = 0.065和ptrend = 0.063），fT3/fT4比值也下降（ptrend = 0.005）。似乎对于接受血液透析治疗的肾衰竭患者，甲状腺疾病的治疗与rT3和转化因子水平的变化无关。