血液透析合并冠心病患者血FT3的水平变化和临床意义

目的观察维持性血液透析(MHD)患者血清游离三碘甲状腺原氨酸(FT3)的水平变化,并探讨其与冠心病的关系。方法选择笔者医院MHD患者(MHD组)85例,健康体检者(对照组)20例。采用免疫化学发光法检测血清FT3、游离甲状腺素(FT4)和促甲状腺激素(TSH)的水平。MHD患者同时测定血红蛋白(Hb)、血白蛋白(ALB)、血肌酐(SCr)、总胆固醇(TC)、甘油三酯(TG)、全段甲状旁腺激素(i PTH)和超敏C反应蛋白(hs CRP)等指标。将MHD患者又分为冠心病组和非冠心病组。结果 MHD组血FT3水平显著低于对照组(P<0.01),与非冠心病组相比,冠心病组FT3水平明显降低(P<0.01)。冠心病组患者年龄较大,透析龄较长,SCr和TG水平低于非冠心病组(P<0.05),ALB水平明显低于非冠心病组(P<0.01),hs CRP水平明显高于非冠心病组(P<0.01)。Spearman相关分析结果显示,MHD患者血FT3水平与Hb(r=0.529,P<0.01)和ALB(r=0.585,P<0.01)呈正相关,与年龄(r=-0.537,P<0.01)和hs CRP(r=-0.485,P<0.01)呈负相关;4 Logistic回归分析,在校正传统和一些非传统的危险因素后,低FT3水平与冠心病发病存在相关性(P<0.01),进一步校正hs CRP或ALB后,该相关性不再存在。结论 MHD患者尤其是合并冠心病患者血FT3水平明显降低,低水平的FT3可能通过炎性反应参与冠心病的发生、发展。

Change of Serum Free Triiodothyronine Level and Its Clinical Significance in Maintenance Hemodialysis Patients with Coronary Heart Disease

Objective To investigate the changes of serum free triiodothyronine(FT3)in maintenance hemodialysis(MHD)patients, and to explore the relationship between FT3and coronary heart disease. Methods Eightyfive MHD patients (MHD group) and twenty healthy people (control group) were enrolled in this study.The serum levels of FT3, free hyroxine(FT4)and thyrotropic-stimulating hormone(TSH) were detected by the immune chemiluminescence method. Hemoglobin(Hb), albumin(ALB), serum creatinine(SCr), total cholesterol(TC), triglyceride(TG), intact parathyroid hormone(iPTH) and high-sensitivity C-reactive protein(hsCRP)were determined.The MHD patients were further divided into coronary heart disease group and non-coronary heart disease group. Results Compared to the control group, serum FT3 levels were significantly decreased in MHD group(P<0.01).The levels of FT3 were also lower in MHD patients with coronary heart disease than those without(P<0.01). The patients in coronary heart disease group were older, and had lower serum SCr, TG and ALB levels, and longer dialysis duration and higher hsCRP compared with the non-coronary heart disease group. The Spearman correlation analysis showed that Serum FT3 level was positively related to Hb(r=0.529, P<0.01)and ALB(r=0.585, P<0.01), and was negatively correlated with age(r=-0.537, P<0.01) and hsCRP (r=-0.485, P<0.01);4Logistic regression analysis revealed that low FT3 is closely associated with coronary heart disease(P<0.01)after adjustment for traditional and non-traditional risk factors. However, adjustments for hsCRP or ALB, there was no relationship between FT3 and coronary heart disease. Conclusion The levels of FT3 in MHD patients with coronary heart disease are significantly decreased. Low FT3 may be implicated in the pathogenesis of atherosclerosis, partly via inflammation.