Boelen A, Platvoet-Ter Schiphorst M C, Wiersinga W M
Department of Endocrinology, Academic Medical Center, University of Amsterdam, The Netherlands.
J Clin Endocrinol Metab. 1993 Dec;77(6):1695-9. doi: 10.1210/jcem.77.6.8263160.
Increased serum concentrations of FFA, bilirubin, and carboxyl-methyl-propyl-furanpropionic acid, accumulating in chronic renal failure in direct relationship with serum creatinine, have all been implicated in the pathogenesis of the low T3 syndrome during illness. Cytokines may also be involved in the sick euthyroid syndrome. In contrast to interleukin-1 (IL-1) and tumor necrosis factor-alpha, IL-6 is usually detectable in serum during illness and acts as a systemic hormone. We studied the association between serum T3 and IL-6 in consecutive hospital admissions with a wide variety of medical conditions. Patients were divided into group A (T3, > or = 1.30 nmol/L; T4, > or = 75 nmol/L; n = 41), group B (T3, < 1.30 nmol/L; T4, > or = 75 nmol/L; n = 46), and group C (T3, < 1.30 nmol/L; T4, < 75 nmol/L; n = 13). Serum IL-6 levels in groups C and B were higher than those in group A (median values 59, 39, and 9 U/mL, respectively; P < 0.01). Serum creatinine and bilirubin/albumin ratios were similar in the three groups, but the FFA/albumin ratio in group C was higher than in group A (P < 0.05). When all patients were analyzed together, serum T3 was negatively correlated to serum IL-6 (r = -0.56; P < 0.001), bilirubin/albumin ratio (r = -0.29; P = 0.004), and FFA/albumin ratio (r = -0.21; P = 0.03), but not with creatinine (r = -0.16; P = 0.11). Stepwise multiple regression resulted in the following equation: serum T3 = 2.13-0.18ln(IL-6)-0.15ln(creatinine)-0.094ln(bilirubin /albumin) (r = 0.61). The variability in serum T3 was accounted for 28% by ln(IL-6), 5% by ln(creatinine), and 4% by ln(bilirubin/albumin). FFA/albumin did not contribute in this respect. We conclude that the low T3 syndrome in nonthyroidial illness is associated with high serum IL-6 levels. However, even when IL-6 is assumed to play a causative role, the variation of serum T3 in NTI-patients remains largely unexplained.
在慢性肾衰竭中，血清游离脂肪酸（FFA）、胆红素和羧基 - 甲基 - 丙基 - 呋喃丙酸的浓度升高，且与血清肌酐直接相关，这些都与疾病期间低T3综合征的发病机制有关。细胞因子也可能参与病态甲状腺综合征。与白细胞介素 - 1（IL - 1）和肿瘤坏死因子 - α不同，IL - 6在疾病期间通常可在血清中检测到，并作为一种全身性激素发挥作用。我们研究了因各种医疗状况连续入院患者的血清T3与IL - 6之间的关联。患者分为A组（T3≥1.30 nmol/L；T4≥75 nmol/L；n = 41）、B组（T3＜1.30 nmol/L；T4≥75 nmol/L；n = 46）和C组（T3＜1.30 nmol/L；T4＜75 nmol/L；n = 13）。C组和B组的血清IL - 6水平高于A组（中位数分别为59、39和9 U/mL；P＜0.01）。三组的血清肌酐和胆红素/白蛋白比值相似，但C组的FFA/白蛋白比值高于A组（P＜0.05）。当对所有患者进行综合分析时，血清T3与血清IL - 6呈负相关（r = -0.56；P＜0.001）、与胆红素/白蛋白比值呈负相关（r = -0.29；P = 0.004）、与FFA/白蛋白比值呈负相关（r = -0.21；P = 0.03），但与肌酐无相关性（r = -0.16；P = 0.11）。逐步多元回归得出以下方程：血清T3 = 2.13 - 0.18ln(IL - 6) - 0.15ln(肌酐) - 0.094ln(胆红素/白蛋白)（r = 0.61）。血清T3的变异性中，ln(IL - 6)占28%，ln(肌酐)占5%，ln(胆红素/白蛋白)占4%。FFA/白蛋白在这方面无贡献。我们得出结论，非甲状腺疾病中的低T3综合征与高血清IL - 6水平相关。然而，即使假设IL - 6起因果作用，非甲状腺疾病患者血清T3的变化在很大程度上仍无法解释。
