【摘要】 目的研究维持性血液透析(maintenance hemodialysis,MHD)患者的残余尿量(residual urine volume,RUV)与甲状腺功能的关系和相互影响。方法选取黄石市第二医院肾病内科2012年10月~2014年10月透析时间大于12月每周2次血液透析的MHD患者79例为研究对象。分别收集患者的RUV、甲状腺激素(thyroid hormone,TH)、和其它临床资料。根据4周内平均每天RUV是否大于100ml将其分为有残余尿组(RUV组,n=22)和无残余尿组(NRUV组,n=49),比较2组各指标的差异。多元logistic回归分析影响RUV的重要因素。分析残余尿量与TH的相关性。以游离三碘甲状腺原氨酸(free triiodothyronine,FT3)是否下降再将RUV组分为2亚组(A亚组:FT3>3.80pmol/l,B组FT3≤3.8 pmol/l)随访2组48周,终点事件定为残余尿量小于平均100ml/24h;采用Kaplan-Meier法分析2组出现终点事件的概率差异。结果 71例患者纳入本研究,RUV为70(130)ml。FT3为(3.67±0.56)pmol/L,下降的有43例(60.6%);游离甲状腺素(free thyroxine,FT4)为8.65(1.5)pmol/L,下降的8例(11.3%);其中FT3与FT4均下降的有6例(8.5%);71例患者人体促甲状腺激素(human thyroid-stimulating hormone,h TSH)为(2.69±1.52m IU/ml)均正常。与NRUV组比较,RUV组透析年限[(1.75±2.03)年比(4.23±2.89)年,t=-4.153,P<0.001)较短、FT3(3.87±0.41)pmol/L比(3.58±0.54)pmol/L,t=2.444,P=0.018]平均值较高、透析充分性Kt/V[(1.27±0.06)比(1.23±0.08),t=2.183,P=0.032]较好、PTH[(181.95(244.35)pg/ml比324.0(370.8)pg/ml,z=2.102,P=0.036]较低、透析中低血压(interdialyitc hypotension,IDH)频数[0.024(0.073)比0.097(0.150),z=2.166,P=0.030]较低。多元logistic回归分析得出FT3(B=1.983,P=0.002)、透析年限(B=-0.388,P=0.007)与RUV密切相关。Spearman等级偏相关性分析在去除透析年限因素影响后,FT3与RUV之间仍呈正相关,偏相关系数为0.603(P<0.001)。随访中B亚组更容易出现残余尿量的减少(Log rankχ~2=9.748,P=0.002)。结论 FT3和透析年限与MHD患者RUV密切相关,临床上应重视MHD患者FT3的变化。更多还原

【Abstract】 Objective To investigate the relationship between thyroid hormones(TH) and residual urine volume(RUV) and their reciprocal influences in maintenance hemodialysis(MHD) patients. Methods We recruited 79 MHD patients treated twice a week for more than 12 months in the period from Oct. 2012 to Oct.2014 in our hospital. Their clinical parameters including RUV and TH were collected. They were then divided into two groups based on RUV: RUV group(RUV >100ml/d, n=22) and NRUV group(RUV <100ml/d, n=49). Clinical parameters were compared between the two groups. Factors influencing RUV were analyzed by using multivariate logistic regression. The relationship between TH and RUV was evaluated. The RUV group was further divided into two subgroups based on free triiodothyronine(FT3): subgroup A(FT3 >3.8 pmol/l)and subgroup B(FT3 ≤3.8 pmol/l). The two subgroups were followed up for one year(48 weeks), and the end points was the event of RUV <100ml/d. The probability difference about the occurrence of end points was evaluated by using Kaplan- Meier method. Results A total of 71 MHD patients with RUV of 70(130) ml were enrolled in this study. FT3 was 3.67 ± 0.56 pmol/l in these patients, including 43 patients(60.6%) with lowered FT3. FT4 was 8.65(1.5) pmol/l in these patients, including 8 patients(11.3%) with lowered FT4. Six patients(8.5%) had both lowered FT3 and FT4. Seventy-one patients were assayed for TSH, and they were all normal. In RUV group, dialysis vintage was shorter(1.75±2.03 vs. 4.23±2.89 years; t=-4.153, P<0.001), FT3 was higher(3.87±0.41 vs. 3.58±0.54 pmol/l; t=2.444, P=0.018), Kt/V was higher(1.27±0.06 vs. 1.23±0.08; t=2.183, P=0.032), PTH was lower [181.95(244.35) vs. 324.0(370.8) pg/ml; z=2.102, P=0.036], and the occurrence of interdialytic hypotension was lower [0.024(0.073) vs. 0.097(0.150); z=2.166, P=0.030], as compared with those in NRUV group. Multivariate logistic regression found that FT3 and dialysis vintage were correlated significantly with RUV(B=1.983, P=0.002 for FT3; B=- 0.388, P=0.007 for dialysis vintage). Spearman rank partial correlation analysis revealed that FT3 was positively correlated with RUV(R=0.603, P<0.001)after excluding the factor of dialysis vintage. In the follow-up period we found that RUV decreased frequently in the B subgroup of RUV group(χ~2=9.748, P=0.002). Conclusions FT3 and dialysis vintage were significantly correlated with RUV in MHD patients. Clinically, we should pay attention to the change of FT3 in MHD patients.更多还原