【摘要】 目的调查非透析慢性肾脏病(CKD)患者亚临床甲状腺功能减退症(SCH)的患病情况,探讨其危险因素。方法连续选取2009年9月—2011年8月在河南省人民医院肾病风湿免疫科住院的非透析CKD患者1 639例为研究对象,符合条件者共1 432例,检测其血糖、肌酐、总胆固醇、三酰甘油、清蛋白、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,计算估计肾小滤过率(eGFR);对SCH相关因素进行单因素分析和多因素Logistic回归分析。结果本组1 432例CKD患者共检出SCH患者226例,SCH患病率为15.80%。不同性别CKD患者SCH患病率比较,差异无统计学意义(P>0.05);以60岁为界,不同年龄CKD患者SCH患病率比较,差异有统计学意义(P<0.05);不同eGFR CKD患者SCH患病率比较,差异亦有统计学意义(P<0.05)。单因素分析显示,SCH组和非SCH组年龄、三酰甘油、空腹血糖、FT4、TSH水平及eGFR比较,差异均有统计学意义(P<0.05);性别、总胆固醇、清蛋白水平比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,年龄和eGFR均是SCH的危险因素,校正其他相关因素后,年龄每增加1岁,SCH患病风险升高2.1%;eGFR每减少1 ml.min-1.(1.73 m2)-1,SCH患病风险升高1.6%。结论非透析CKD患者SCH患病率较高,年龄、eGFR是其发生的独立危险因素,对老年CKD患者,尤其eGFR<15 ml.min-1.(1.73 m2)-1者应注意监测其甲状腺功能。更多还原

【Abstract】 Objective To investigate the prevalence of subclinical primary hypothyroidism(SCH) in patients with non-dialysis chronic kidney disease(CKD) and analyze the relevant factors.Methods Totally 1 639 hospitalized adult patients with non-dialysis CKD were enrolled in this study.The baseline demographic characteristics as well as the clinical and laboratory data of these patients were collected.After patients with abnormal serum free thyroxine(FT4) were excluded,1 432 patients entered the final analysis.Multivariable logistic regression method was used to evaluate the association between prevalence of SCH and the possible relevant factors.Results Among these 1 432 patients,226(15.80%) were with SCH.The prevalence of SCH showed no significant difference between male and female patients(P>0.05).However,it showed significantly difference between patients older than 60 years and those below 60 years(P<0.05) and among patients with eGFR level.Univariate analysis showed age,triglyceride,fasting blood glucose,FT4,TSH,and eGFR were significantly different bwteen SCH group and non-SCH group(all P<0.05),whereas gender,total cholesterol,and albumin showed no such difference(P>0.05).Multivariate Logistic regression analysis showed both age and eGFR were the risk factor of SCH.After adjusting for other factors,the relative risk of developing SCH increased by 0.021 as participants with one year increase of age(OR=1.021,95% CI(1.010~1.032),P<0.001).At the same time,after adjusting for the other factors,the relative risk of SCH decreased by 0.016 as decreasing 1ml·min-1·(1.73 m2)-1 of eGFR(OR=0.016,95%CI(1.011~1.021),P<0.001).Conclusion The prevalence of SCH is high among adult hospitalized-patients with non-dialysis CKD.eGFR and age are independent predictors of SCH.The thyroid function should be carefully monitored among elderly CKD patients,especially in those with eGFR less than 15ml·min-1·(1.73 m2)-1.更多还原