慢性肾衰竭中甲状腺激素与营养的关系

Relationship between thyroid hormones and nutrition in chronic renal failure.

作者信息

Verger M F, Verger C, Hatt-Magnien D, Perrone F

出版信息

Nephron. 1987;45(3):211-5. doi: 10.1159/000184119.

Abstract

A cross-sectional study was performed in 19 patients on haemodialysis and in 11 on continuous ambulatory peritoneal dialysis (CAPD) in order to investigate the relationship between thyroid hormones and nutritional status. T4, T3 resin uptake, T3, rT3 and TSH were measured by radio-immunoassay and compared with controls. Nutritional status was assessed by measurements of blood proteins, albumin, gamma-globulin, transferrin, arm muscle circumference and triceps skinfold thickness. In haemodialysis, T4, FTI, T3 and rT3 were significantly decreased. TSH was normal. In CAPD, thyroid hormones were normal. In both groups, proteins, albumin, gamma-globulin and transferrin were normal. Triceps skinfold thickness was normal in males and females, whereas arm muscle area was dramatically reduced in males and normal in females. In haemodialysis, a negative correlation was found between T3 and proteins (p less than 0.01), rT3 versus proteins (p less than 0.01) and versus gamma-globulin (p less than 0.01). In CAPD, a positive correlation was found between T3 and triceps skinfold thickness (p less than 0.05). We suggest that the overload of carbohydrate might normalize the thyroid hormones in patients on CAPD. The relationship between thyroid hormones and nutritional status in patients treated by dialysis suggests a putative protective effect of low T3 levels against protein breakdown.

摘要

为了研究甲状腺激素与营养状况之间的关系，对19例血液透析患者和11例持续性非卧床腹膜透析（CAPD）患者进行了一项横断面研究。通过放射免疫分析法测定T4、T3树脂摄取、T3、反T3（rT3）和促甲状腺激素（TSH），并与对照组进行比较。通过测量血液蛋白质、白蛋白、γ-球蛋白、转铁蛋白、上臂肌肉周长和肱三头肌皮褶厚度来评估营养状况。在血液透析患者中，T4、游离甲状腺素指数（FTI）、T3和rT3显著降低，TSH正常。在CAPD患者中，甲状腺激素正常。两组患者的蛋白质、白蛋白、γ-球蛋白和转铁蛋白均正常。男性和女性的肱三头肌皮褶厚度均正常，而男性的上臂肌肉面积显著减少，女性则正常。在血液透析患者中，发现T3与蛋白质之间呈负相关（p<0.01），rT3与蛋白质之间呈负相关（p<0.01），与γ-球蛋白之间呈负相关（p<0.01）。在CAPD患者中，发现T3与肱三头肌皮褶厚度之间呈正相关（p<0.05）。我们认为，碳水化合物负荷过重可能使CAPD患者的甲状腺激素恢复正常。透析患者中甲状腺激素与营养状况之间的关系表明，低T3水平对蛋白质分解可能具有潜在的保护作用。