Sanai Toru, Okamura Ken, Onoue Tomoaki, Ono Takashi, Motomura Kenichi, Miyazono Motoaki, Shimamatsu Kazumasa
Department of Nephrology, Fukumitsu Clinic, Fukuoka, Japan,
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,
Am J Nephrol. 2021 Feb 1;51(12):988-994. doi: 10.1159/000512968.
To elucidate the role of hemodilution in the alteration of thyroid hormone levels in end-stage renal disease (ESRD), we compared thyroid function before and after hemodialysis (HD).
Twenty-three male ESRD patients (age <65 years) with either chronic glomerulonephritis (CGN) or diabetic nephropathy (DN), who were enrolled between June 2019 and August 2019, were included in the study. The free thyroxine (fT4), free tri-iodothyronine (fT3), and thyroid-stimulating hormone (TSH), thyroxine-binding globulin (TBG), and thyroglobulin (Tg), measured before and after HD in 12 patients with CGN (48.7 ± 11.8 years [mean ± standard deviation]) and 11 patients with DN (57.6 ± 6.5 years), were compared with 45 healthy controls (52.5 ± 11.9 years).
The fT4, fT3, and TBG were significantly low before HD and increased in parallel with an increase in hematocrit and albumin after HD in both ESRD subgroups. The TSH was high before HD and decreased significantly after HD, while Tg remained almost unchanged. In DN, the fT4 levels were nearly identical, while fT3 was lower with slightly higher TSH, compared with CGN. The TSH/fT4 ratios before HD were significantly higher in both subgroups, and the fT3/fT4 ratios after HD were significantly lower in DN than the control.
Our findings suggest that the low fT4 and fT3 levels found in ESRD are due to hemodilution before HD, resulting in a slightly higher TSH level but almost unchanged Tg level, and that DN is associated with decreased T4-to-T3 conversion.
为阐明血液稀释在终末期肾病（ESRD）患者甲状腺激素水平改变中的作用，我们比较了血液透析（HD）前后的甲状腺功能。
纳入2019年6月至2019年8月期间登记的23例年龄小于65岁、患有慢性肾小球肾炎（CGN）或糖尿病肾病（DN）的男性ESRD患者。比较了12例CGN患者（48.7±11.8岁[均值±标准差]）和11例DN患者（57.6±6.5岁）HD前后测定的游离甲状腺素（fT4）、游离三碘甲状腺原氨酸（fT3）、促甲状腺激素（TSH）、甲状腺素结合球蛋白（TBG）和甲状腺球蛋白（Tg），并与45名健康对照者（52.5±11.9岁）进行比较。
在两个ESRD亚组中，HD前fT4、fT3和TBG显著降低，HD后随着血细胞比容和白蛋白增加而平行升高。TSH在HD前较高，HD后显著降低，而Tg几乎保持不变。与CGN相比，DN患者的fT4水平几乎相同，而fT3较低，TSH略高。两个亚组HD前的TSH/fT4比值均显著较高，DN患者HD后的fT3/fT4比值显著低于对照组。
我们的研究结果表明，ESRD患者中发现的低fT4和fT3水平是由于HD前的血液稀释，导致TSH水平略高但Tg水平几乎不变，并且DN与T4向T3的转化减少有关。
