上海交通大学学报(医学版) ›› 2017, Vol. 37 ›› Issue (11): 1501-.doi: 10.3969/j.issn.1674-8115.2017.11.009

• 论著(临床研究) • 上一篇    下一篇

低T 3 综合征可预测腹膜透析患者的不良预后

闵丹燕 1, 2,陆晓蓉 1*,李振元 1,严豪 1,张敏芳 1,王琴 1,袁江姿 1,倪兆慧 1,方炜 1   

  1. 1. 上海交通大学 医学院附属仁济医院肾脏科,上海市腹膜透析研究中心,上海 200127;2. 上海市浦东新区周浦医院肾脏科,上海 201318
  • 出版日期:2017-11-28 发布日期:2018-01-10
  • 通讯作者: 方炜,电子信箱:fangwei_sh@126.com
  • 作者简介:闵丹燕(1980—),女,主治医师,硕士生;电子信箱:mdy211@sohu.com。陆晓蓉(1990—),女,住院医师,硕士;电子信箱:328829215@qq.com。 *共同第一作者
  • 基金资助:
    上海市教育委员会高峰高原学科建设计划(20152211);国家自然科学基金(81370814,81670691)

Low triiodothyronine syndrome can predict poor prognosis in peritoneal dialysis patients#br#

MIN Dan-yan1, 2, LU Xiao-rong1*, LI Zhen-yuan1, YAN Hao1, ZHANG Min-Fang1, WANG Qin1, YUAN Jiang-zi1, NI Zhao-hui1, FANG Wei1   

  1. 1. Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai 200127, China;  2. Department of Nephrology, Shanghai Pudong New District Zhoupu Hospital, Shanghai 201318, China
  • Online:2017-11-28 Published:2018-01-10
  • Supported by:
    (Shanghai Municipal Education Commission— Gaofeng Clinical Medicine Grant Support, 20152211; National Natural Science Foundation of China, 81370814, 81670691)

摘要: 目的 · 研究腹膜透析患者低 T3 综合征(LT3S)的发生情况,并探讨其对患者长期预后的预测价值。方法 · 入选 2009 年 1 月— 2015 年 12 月在上海交通大学医学院附属仁济医院腹膜透析中心开始维持性腹膜透析治疗且稳定腹膜透析≥ 3 个月的慢性肾脏病患者 477 例,比较 LT3S 组(218 例)和正常 T3 组(259 例)患者生化指标。采用多因素 Cox 风险回归模型分析游离三碘甲状腺原氨酸(FT3) 对腹膜透析患者全因死亡、心血管疾病(CVD)死亡的预测价值。结果 · 与正常 T3 组患者相比,LT3S 组血红蛋白 [ (97.90±23.71) g/L vs (105.54±22.94)g/L]、血校正钙[ (2.06±0.35)mmol/L vs (2.17±0.27)mmol/L] 均 较 低( 均P <0.01), LT3S 组脑钠肽{[311.00 (134.59,776.00) pg/mL] vs [159.00(58.28,378.75) pg/mL]}、高敏 C- 反应蛋白 {[2.85(0.95,6.81) mg/L] vs [1.34(0.54,3.32) mg/L]}、总胆固醇 [ (3.18±1.29)mmol/L vs (2.76±0.93)mmol/L] 均较高(均 P<0.01);LT3S组患者的左心室心肌质量指数 {[ (154.16±58.15)g/m2]  vs [ (125.24±42.67)g/m2],P<0.01} 明显增高。多因素Cox 风险回归模型显示,FT3 水平与腹膜透析患者全因死亡(HR 0.51, 95% CI 0.41 ~ 0.63,P<0.01)和CVD 死亡(HR 0.60,95% CI 0.45 ~ 0.81,P<0.01)独立相关。结论 · 腹膜透析患者LT3S 的发生 率较高,低 FT3 水平是腹膜透析患者全因死亡和 CVD 死亡的独立危险因素。

关键词: 腹膜透析, 低 T3 综合征, 全因死亡, 心血管疾病死亡

Abstract:

 Objective · To investigate the prevalence of low triiodothyronine syndrome (LT3S) in peritoneal dialysis (PD) patients and to evaluate the predictive value of long-term prognosis.  Methods · From Jan. 2009 to Dec. 2015, all patients who started PD for 3 months were enrolled. According to thyroid hormone levels, there were classified into LT3S group (218 cases) and normal T3 group (259 cases). The association between FT3 and mortality in PD patients was estimated using Cox risk regression model.  Results · Compared to the patients in normal T3 group, patients with LT3S had lower hemoglobin [(97.90±23.71)g/L vs (105.54±22.94)g/L], adjusted serum calcium [(2.06±0.35)mmol/L vs (2.17±0.27)mmol/L] (all P<0.01). Patients with LT3S had higher BNP {[311.00(134.59,776.00)pg/mL] vs [159.00(58.28,378.75)pg/mL]}, hrCRP {[2.85(0.95, 6.81)mg/L] vs [1.34(0.54, 3.32) mg/L]}
 and serum total cholesterol [(3.18±1.29)mmol/L vs (2.76±0.93)mmol/L] than that in patients with normal T3 group (all P<0.01). LVMI of LT3S group [(154.16±58.15)g/m2] vs (125.24±42.67)g/m2] was much higher than that of normal T3 group (P<0.01). Cox risk regression model indicated that FT3 was significantly associated with all-cause mortality (HR 0.51, 95% CI 0.41-0.63; P<0.01) and cardiovascular mortality (HR 0.60, 95% CI 0.45-0.81; P<0.01).  Conclusion · LT3S is common in PD patients. Lower FT3 was an independent risk factor of  all-cause and cardiovascular mortality in PD patients.

Key words:  peritoneal dialysis, low triiodothyronine syndrome, all-cause mortality, cardiovascular disease mortality

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