血液透析对血清甲状腺激素和促甲状腺素水平的影响及意义

本文介绍了用放射免疫法测定的43和67例正常人、35例尿毒症患者(保守治疗组14例、血液透析治疗组21例)血清游离T_3(FT_3)、游离T_4(FT_4)、总T_3(TT_3)、总T_4(TT_4)和促甲状腺素(TSH_(1RMA))水平,观察到虽然尿毒病患者甲状腺功能正常,但是血清FT_3、FT_4和TT_3平均水平明显降低,TT_4和TSH_(1RMA)正常。FT_3、FT_4、TT_3和TT_4低于正常值的出现频率,在保守治疗组分别为35.7、42.9、50和21％,在血透治疗组分别为81、38.1、61.9和14.2％。一次性透析后血清TSH_(1RMA)水平明显降低而血清FT_3、FT_4、TT_3和TT_4没有变化。维持性透析过程中未见血清甲状腺素水平变化。对上述变化进行了讨论,认为TSH_(1RMA)水平在尿毒症患者中评定甲状腺功能状态是一个有用的指标。

Effects of Hemodialysis on the Serum Thyroid Hormone and TSH Levels

Serum levels of free T_3(FT_3), free T_4(FT_4), total T_3(TT_3), total T_4(TT_4) and TSH_(IRLA) were measured in 43 and 67 normal subjects, 35 uremic patients (conservative 14, hemodialysis ones 21). Significamly lowered mean serum FT_3, FT_4 and TT_3 but normal T_4 and TSH_(IRMA) were observed in untreated uremic and hemodialysis ones, although all the subjects were euthyroid. The rates of low FT_3, FT_4, TT_3 and TT_4 were 37.5, 42.9, 50 and 21% in conservative uremic patients and 81, 38.1, 61.9 and 14.2% in hemodialysis patients respectively. The postdialysis TSH_(IRMA) level was significantly reduced and FT_3, FT_4, TT_3 and TT_4 were unchanged after transient hemodialysis. There was no change of the rates of low FT_3, FT_4, TT_3 and TT_4 in the couse of maintained dialysis. The conclusion is that FT_3, FT_4, TT_3 and TT_4 are lowered in parts of conservative uremic and hemodialysis patient but TSH_(IRMA) is normal or only slightly low. The thyroid function of them is most likely normal (euthyroid). TSH_(IRMA) is a useful index in diagnosing hypothyroidism in uremic and hemodialysis patients. Transient and maintained hemodialysis do not dramaticaly change the thyroid hormone and TSH_(IRMA) levels.