前瞻性血液透析队列中血清促甲状腺激素水平升高与血管内皮功能障碍。
Elevated serum thyrotropin levels and endothelial dysfunction in a prospective hemodialysis cohort.
机构信息
Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA.
Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA.
出版信息
Hemodial Int. 2022 Jan;26(1):57-65. doi: 10.1111/hdi.12964. Epub 2021 Jul 6.
INTRODUCTION
Thyroid dysfunction is a highly prevalent yet under-recognized complication in hemodialysis patients. In the general population, hypothyroidism has been associated with endothelial dysfunction due to impaired vasodilator synthesis and activity. Little is known about the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with endothelial function in hemodialysis patients.
METHODS
In a secondary analysis of 99 patients from the Anti-inflammatory and anti-oxidative nutrition in hypoalbuminemic dialysis patients (AIONID) trial, we examined measurements of serum TSH and endothelial function ascertained by fingertip digital thermal monitoring (DTM), a novel method used to measure micro-vascular reactivity, collected within a 90-day period. DTM was used to measure changes in fingertip temperature during and after an ischemic stimulus (blood pressure cuff occlusion) as an indicator of changes in blood flow, and two DTM indices were assessed, namely adjusted (a) Temperature Rebound (TR), defined as the maximum temperature rebound post-cuff deflation, and adjusted (b) Area Under the Temperature Curve (TMP-AUC), defined as area under the curve between the maximum and minimum temperatures. We examined the relationship between serum TSH with impaired TR (separately) and TMP-AUC (both defined as less than the median level of observed values) using multivariable logistic regression.
FINDINGS
In unadjusted and case-mix analyses, higher serum TSH levels (defined as the three highest quartiles) were associated with lower (worse) TR (ref: lowest TSH quartile): ORs (95% CI) 2.64 (1.01-6.88) and 2.85 (1.08-7.57), respectively. In unadjusted and case-mix analyses, higher TSH levels were associated with lower (worse) TMP-AUC: ORs (95% CI) 2.64 (1.01-6.88) and 2.79 (1.06-7.38), respectively.
DISCUSSION
In HD patients, higher serum TSH levels were associated with worse micro-vascular reactivity measured by DTM. Further studies are needed to determine if thyroid hormone supplementation improves endothelial function in hemodialysis patients with lower levels of thyroid function.
简介
甲状腺功能障碍是血液透析患者中一种高发但未被充分认识的并发症。在普通人群中，由于血管舒张剂合成和活性受损，甲状腺功能减退与内皮功能障碍有关。关于血清促甲状腺激素（TSH）——甲状腺功能最敏感和最特异的单一生化指标——与血液透析患者内皮功能的关系，知之甚少。
方法
在 Anti-inflammatory and anti-oxidative nutrition in hypoalbuminemic dialysis patients (AIONID) 试验的 99 名患者的二次分析中，我们检查了在 90 天内收集的指尖数字热监测（DTM）确定的血清 TSH 和内皮功能测量值，DTM 是一种用于测量微血管反应性的新方法。DTM 用于测量缺血刺激（血压袖带充气）过程中和之后指尖温度的变化，作为血流变化的指标，并评估了两个 DTM 指数，即调整后的（a）温度反弹（TR），定义为袖带放气后的最大温度反弹，以及调整后的（b）温度曲线下面积（TMP-AUC），定义为最大和最小温度之间的曲线下面积。我们使用多变量逻辑回归检查了血清 TSH 与受损的 TR（分别）和 TMP-AUC（两者均定义为低于观察值中位数水平）之间的关系。
结果
在未调整和病例组合分析中，较高的血清 TSH 水平（定义为三个最高四分位数）与较低（较差）的 TR（参考：最低 TSH 四分位数）相关：比值比（95%CI）分别为 2.64（1.01-6.88）和 2.85（1.08-7.57）。在未调整和病例组合分析中，较高的 TSH 水平与较低（较差）的 TMP-AUC 相关：比值比（95%CI）分别为 2.64（1.01-6.88）和 2.79（1.06-7.38）。
讨论
在血液透析患者中，较高的血清 TSH 水平与 DTM 测量的微血管反应性较差相关。需要进一步的研究来确定甲状腺激素补充是否可以改善甲状腺功能较低的血液透析患者的内皮功能。
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