血液透析和持续性非卧床腹膜透析患者促甲状腺激素对促甲状腺激素释放激素的反应

TSH response to TRH in hemodialysis and CAPD patients.

作者信息

Giordano C, De Santo N G, Carella C, Mioli V, Bazzato G, Amato G, Di Leo V A, Tarchini G, Coli U, Capodicasa G

出版信息

Int J Artif Organs. 1984 Jan;7(1):7-10.

Abstract

The thyroid status was studied in 19 uremic patients (11 on HD and 8 on CAPD) and in a group of 17 healthy adult patients. In uremic patients T3 and T4 were significantly reduced (p less than 0.001) and rT3 was increased (p less than 0.001). The time course TSH response to TRH showed a lower peak response (in 5 patients it did not exceed 5 microU/ml) which on turn was also delayed (the peak was observed at 60 minutes in 63% of them). TSH concentrations in uremics were increased at 0 time (p less than 0.02), lower at 20 minutes (p less than 0.01) and increased at 120 minutes (p less than 0.02). No difference existed between HD and CAPD. The thyroid response to TSH was normal as showed by a normal percent increase over basal values of T3 concentrations at 120 minutes. Uremic patients also showed a peak GH response at 20 minutes which was not observed in controls. The data exclude the existence on a primary form of hypothyroidism and point to the existence of hypothalamic-pituitary abnormalities, which should not be taken as indicative of secondary and/or tertiary hypothyroidism since FT4 values were normal in HD and increased in patients undergoing CAPD (p less than 0.05) who on turn showed lower plasma albumin concentrations (p less than 0.05).

摘要

对19例尿毒症患者（11例接受血液透析，8例接受持续性非卧床腹膜透析）及17例健康成年患者的甲状腺状态进行了研究。尿毒症患者的T3和T4显著降低（p<0.001），反T3升高（p<0.001）。促甲状腺激素（TSH）对促甲状腺激素释放激素（TRH）的反应时间过程显示峰值反应较低（5例患者峰值未超过5μU/ml），且反应延迟（63%的患者在60分钟时观察到峰值）。尿毒症患者的TSH浓度在0时升高（p<0.02），20分钟时降低（p<0.01），120分钟时升高（p<0.02）。血液透析和持续性非卧床腹膜透析之间无差异。120分钟时T3浓度相对于基础值的正常升高百分比表明甲状腺对TSH的反应正常。尿毒症患者在20分钟时也出现生长激素（GH）反应峰值，而对照组未观察到。这些数据排除了原发性甲状腺功能减退症的存在，并表明存在下丘脑 - 垂体异常，鉴于血液透析患者的游离甲状腺素（FT4）值正常，而接受持续性非卧床腹膜透析的患者FT4升高（p<0.05），且后者血浆白蛋白浓度较低（p<0.05），不应将其视为继发性和/或三发性甲状腺功能减退症的指征。