Kaptein E M, Quion-Verde H, Chooljian C J, Tang W W, Friedman P E, Rodriquez H J, Massry S G
Department of Medicine, University of Southern California, Los Angeles.
Medicine (Baltimore). 1988 May;67(3):187-97. doi: 10.1097/00005792-198805000-00005.
Previous studies of patients with end-stage renal disease (ESRD) indicate that the prevalence of goiter varies from 0 to 58% while that of hypothyroidism ranges from 0 to 9.5%. In addition, altered serum thyroid hormone levels are present in euthyroid patients with ESRD and may be related to nonthyroidal disorders including malnutrition. To examine these issues further, 306 patients with ESRD were compared to 139 hospitalized patients without renal disease (control population). Goiter was present in 43% with ESRD compared to 6.7% of controls (P less than 0.001). Goiter frequency was greater (49.6%, P = 0.047) and serum parathyroid hormone levels higher (mean: 238.6 microlitersEq/ml, P less than 0.001; normal: less than 15 microlitersEq/ml) in 115 patients dialyzed for longer than 1 year than in 191 dialyzed for less than 1 year or not at all (38.7%, and 61.5 microlitersEq/ml, respectively). In addition, goiter was more common in females (50.0%) than in males (35.1%, P = 0.008) with ESRD. No significant relationships were observed between goiter frequency and age, race, diabetes mellitus, or elevated antimicrosomal antibody titers. The prevalence of primary hypothyroidism was higher in ESRD (2.6%) than in 2122 in- and out-patients (1.1%) (P = 0.024). Compared to the total group of ESRD patients, the hypothyroid patients were predominantly female (88% vs. 50%) and had a higher frequency of positive antimicrosomal antibody titers (50% vs. 6.7%, P = 0.029). The frequency of hyperthyroidism was not significantly different, being 1.0% in ESRD compared to 0.3% in the general population (P = 0.057). There was a higher frequency of reduced free T4 index values in the 287 euthyroid patients with ESRD (12.9%) than in controls (3.6%) (P = 0.002). Similarly, free T3 index values were reduced below 100 in 65.5% with ESRD compared to 33.8% of controls (P less than 0.001). In addition, serum albumin levels were lower in euthyroid patients with ESRD (3.5 g/dl, P less than 0.001) than in controls (3.8 g/dl). Serum T3 levels correlated directly with both serum albumin (r = 0.57, P less than 0.001) and transferrin (r = 0.54, P less than 0.001) levels in ESRD as well as in controls (r = 0.74, P less than 0.001, and r = 0.69, P less than 0.001, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)
以往对终末期肾病（ESRD）患者的研究表明，甲状腺肿的患病率在0%至58%之间，而甲状腺功能减退的患病率在0%至9.5%之间。此外，ESRD的甲状腺功能正常患者存在血清甲状腺激素水平改变的情况，这可能与包括营养不良在内的非甲状腺疾病有关。为了进一步研究这些问题，将306例ESRD患者与139例无肾脏疾病的住院患者（对照人群）进行了比较。ESRD患者中甲状腺肿的发生率为43%，而对照组为6.7%（P<0.001）。115例透析时间超过1年的患者甲状腺肿发生率更高（49.6%，P = 0.047），血清甲状旁腺激素水平也更高（平均值：238.6微升Eq/ml，P<0.001；正常：<15微升Eq/ml），高于191例透析时间少于1年或未透析的患者（分别为38.7%和61.5微升Eq/ml）。此外，ESRD女性患者甲状腺肿更常见（50.0%），男性患者为35.1%（P = 0.008）。未观察到甲状腺肿发生率与年龄、种族、糖尿病或抗微粒体抗体滴度升高之间存在显著关系。ESRD患者中原发性甲状腺功能减退的患病率（2.6%）高于2122例门诊和住院患者（1.1%）（P = 0.024）。与ESRD患者总体相比，甲状腺功能减退患者以女性为主（88%对50%），抗微粒体抗体滴度阳性率更高（50%对6.7%，P = 0.029）。甲状腺功能亢进的发生率无显著差异，ESRD患者为1.0%，普通人群为0.3%（P = 0.057）。287例ESRD甲状腺功能正常患者中游离T4指数值降低的发生率（12.9%）高于对照组（3.6%）（P = 0.002）。同样，ESRD患者中65.5%的游离T3指数值降至100以下，而对照组为33.8%（P<0.001）。此外，ESRD甲状腺功能正常患者的血清白蛋白水平（3.5 g/dl，P<0.001）低于对照组（3.8 g/dl）。ESRD患者以及对照组中，血清T3水平与血清白蛋白（r = 0.57，P<0.001）和转铁蛋白（r = 0.54，P<0.001）水平均呈直接相关（对照组中r分别为0.74，P<0.001和r = 0.69，P<0.001）。（摘要截选至400字）
