老年腹膜透析患者MIA综合征与低T3综合征之间的关系

目的：探讨老年腹膜透析患者营养不良一炎症一动脉硬化综合征（MIA）与低三碘甲腺原氨酸（T，）综合征之间的关系。方法：收集2009年3—4月在北京大学第三医院肾内科进行随访的持续性非卧床腹膜透析患者的临床资料，根据年龄将患者分为老年组（≥65岁，49例）和非老年组（〈65岁，60例）。检测患者的血清TSH、血清游离三碘甲腺原氨酸（FL）、血清游离甲状腺激素（FT4）水平，同时评估血压、主观综合营养评估（SGA）、蛋白氮呈现率（PNA）、肌酐动力法评估的瘦体重（LBM—ck）等指标。结果：老年组患者营养不良发生率、C反应蛋白水平、脉压、低T3综合征发生率分别为28．6％、（9．02±10．4）mg／L、（60．2±15．0）mmHg〈42．9％，比非老年组的8．3％、（3．43±5．09）mg／L、（52．0±20．2）mmHg、21．7％更高（P〈0．05）；老年组患者FT3水平为（2．41±0．35）pg／mL，低于非老年组的（2．57±0．31）pg／mL（P〈0．05）。老年组患者血清FT3水平与LBM—ck、PNA呈正相关（r=0．297、0．385，P〈0．05），而与C反应蛋白水平、脉压呈负相关（r=-0．302、-0．284，P〈0．05）。结论：老年腹膜透析患者更易罹惠MIA，且低血清FT3与MIA之间关系密切，MIA与低T3综合征之间可能存在恶性循环的通路。

Association between malnutrition-inflammation-arteriosclerosis syndrome and low triiodothyronine syndrome in the elderly patients undergoing peritoneal dialysis

Objective：To explore the association between malnutrition-inflammation-arteriosclerosis （MIA） syndrome and low triiodothyronine （ T3 ） syndrome in the elderly patients undergoing peritoneal dialysis （PD）. Methods：The clinical data were collected of the patients who had undergone continuous ambulatory peritoneal dialysis between March and April, 2009 in the Division of Nephrology, Peking University Third Hospital. All the patients were divided into 2 groups by age （ t〉 65 vs 〈 65 years）. The levels of thyrotropic-stimulating hormone （TSH）, free triiodothyronine （FT3 ） and free thyroxine （FT4） were detected and arterial pulse pressure （PP）, subjective global nutritional assessment （SGA）, protein nitrogen appearance （PNA） and lean body mass （LBM） were assessed. Results： There were 49 patients in the I〉65 group and 60 in the 〈 65 group. The prevalence of malnutrition, serum C-reactive protein （ CRP）, PP and prevalence of low T3 syndrome in the /〉65group were respectively 28.6%, （9.02 ± 10.4 ） mg/L, （60.2 ± 15.0） mmHg and 42.9%, significantly higher than those in the 〈65 group 8.3%, （3.43 ±5.09） mg/L, （52.0 ±20.2） mmHg, and 21.7% ] （P 〈0. 05 ）. A significant lower level of serum FT3 was found in older patients than in younger ones （ 2.41 ± 0.35 ） pg/mL vs （2.57 ± 0.31 ） pg/mL, P 〈 0.05 ]. The serum FT3 levels in the ≥65 group were positively associated with LBM- ck and PNA （r = 0. 297, 0. 385, P 〈 0.05, P 〈 0.05） but negatively associated with CRP and PP （ r = - 0. 302, -0. 284, P 〈 O. 05）. Conclusion： Older PD patients may be more susceptible to MIA syndrome, which has a close association with low serum FT3 , than younger ones. A vicious circle may exist between MIA syndrome and low W3 syndrome.