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。

 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.