Musavi Mehdiabadi Fatemeh, Rashidinejad Alireza, Mahdavi Amin, Dehesh Tania
Department of Nephrology, Kerman University Of Medical Sciences, Kerman, Iran.
Iran J Kidney Dis. 2020 Sep;14(5):380-388.
Non-thyroidal illness is prevalent in patients with advanced stages of chronic kidney disease and could be considered as a risk factor for cardiovascular mortality; this relation is partially explained by malnutrition and the concomitant condition of high inflammation. This study is designed to investigate the relationship between left ventricular mass and thyroid hormone abnormalities and evaluate this relationship after adjustment of inflammatory factors and nutritional status in peritoneal dialysis patients.
A total of 71 patients undergoing maintenance peritoneal dialysis were included. Serum concentration of total and free triiodothyronine (fT3), total and free thyroxine (fT4), and TSH were measured. LV mass index and the structural properties of heart including LVEDD, LVESD, PWD, and EF were assessed by transthoracic echocardiography. The Surrogates of Inflammation, including IL-6, albumin, and hs-CRP were measured. The nutritional status of patients was assessed by one point SGA scoring and biochemical data. The relation between thyroid hormones and echocardiographic variables, inflammatory and nutritional markers was determined.
LVMI was significantly higher in the group with lower fT3 levels. Linear regression analyses showed statistically significant univariate association between fT3, tT3, and tT4; and LVMI. In multiple linear regression analysis adjusted for albumin, hs-CRP, IL- 6, and ferritin; only fT3 level had a meaningful negative correlation (P < .05) with LVMI, free T3 level was positively correlated with rGFR (P < .05, c = 0.39) and KT/V (P < .05, c = 0.27).
Low fT3 level was negatively and significantly associated with LVML even after adjustments for known risk factors in peritoneal dialysis patients.
非甲状腺疾病在慢性肾脏病晚期患者中普遍存在，可被视为心血管死亡的危险因素；这种关系部分可由营养不良和高炎症的伴随状况来解释。本研究旨在调查左心室质量与甲状腺激素异常之间的关系，并在调整腹膜透析患者的炎症因子和营养状况后评估这种关系。
共纳入71例接受维持性腹膜透析的患者。测量血清总三碘甲状腺原氨酸（tT3）、游离三碘甲状腺原氨酸（fT3）、总甲状腺素（tT4）、游离甲状腺素（fT4）和促甲状腺激素（TSH）的浓度。通过经胸超声心动图评估左心室质量指数以及心脏的结构特性，包括左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、后壁厚度（PWD）和射血分数（EF）。测量炎症替代指标，包括白细胞介素-6（IL-6）、白蛋白和高敏C反应蛋白（hs-CRP）。通过单点评分主观全面评定法（SGA）评分和生化数据评估患者的营养状况。确定甲状腺激素与超声心动图变量、炎症和营养标志物之间的关系。
fT3水平较低的组中左心室质量指数（LVMI）显著更高。线性回归分析显示fT3、tT3和tT4与LVMI之间存在统计学上显著的单变量关联。在对白蛋白、hs-CRP、IL-6和铁蛋白进行校正的多元线性回归分析中，只有fT3水平与LVMI存在有意义的负相关（P < 0.05），游离T3水平与肾小球滤过率（rGFR）呈正相关（P < 0.05，c = 0.39），与尿素清除指数（KT/V）呈正相关（P < 0.05，c = 0.27）。
即使在对腹膜透析患者的已知危险因素进行校正后，低fT3水平仍与左心室质量呈显著负相关。
