原发性甲状腺功能减退症患者的血清肌酐水平和影响因素

  目的  探讨原发性甲状腺功能减退症(甲减)患者血清肌酐(creatinine, Cr)水平变化及其影响因素。  方法  回顾性分析北京协和医院内分泌科2006年1月至2010年12月诊治的27例甲减患者的临床资料, 并根据血清游离甲状腺素(free thyroxine, FT₄)水平将患者分为临床甲减组和亚临床甲减组。使用Cockcroft-Gault公式计算患者肌酐清除率(creatinine clearance rate, CCr)。分析患者血清Cr、尿素氮、CCr与甲状腺功能以及血清肌酸激酶间的关系。  结果  14.8%的患者血清Cr水平超过正常上限。本组患者血清Cr和血清游离三碘甲腺原氨酸(free triiodothyronine, FT₃)(P < 0.001, r=-0.628)、FT4(P=0.016, r=-0.458)间均呈负相关。临床甲减组血清Cr水平明显高于亚临床甲减组(99.89±28.93)μmol/l比(74.67±8.03)μmol/l, P < 0.01]。而甲状腺激素治疗后, FT₄明显升高(P=0.005), 血清Cr明显降低(P=0.001)。Cr和经对数转换的血清肌酸激酶间呈正相关(P=0.032, r=0.596), CCr和FT₄呈正相关(P=0.043, r=0.527)。  结论  临床上发现血清Cr水平增高的患者应常规筛查甲状腺功能。血清Cr水平的增高与CCr的下降以及肌肉的破坏均有关。甲状腺功能纠正后, 甲减引起的血清Cr水平的增高可恢复正常。

Serum Creatinine Level and Its Influencing Factors in Patients with Primary Hypothyroidism

Objective　　To explore the changes of serum creatinine (Cr) level in patients with primary hypothyroidism and the influencing factors of serum Cr level. Methods　　We retrospectively analyzed the clinical data of 27 patients with primary hypothyroidism who were treated at Peking Union Medical College Hospital between January 2006 and December 2010. The patients were divided into two groups according to the level of serum free thyroxine (FT4), i.e. clinical hypothyroidism group and subclinical hypothyroidism group. We calculated the creatinine clearance rate (CCr) with Cockcroft-Gault Formula and analyzed the relationship of serum Cr, blood urea nitrogen, and CCr with thyroid function and serum creatine kinase (CK). Results　　The serum Cr levels in 14.8% of the patients exceeded the normal range. The serum levels of Cr were negtively correlated with free triiodothyronine (FT3) (P＜0.0001, r=－0.628) and FT4 (P=0.016, r=－0.458). The serum Cr level in the clinical hypothyroidism group was higher than in the subclinical hypothyroidism group［(99.89±28.93)μmol/L vs. (74.67±8.03)μmol/L, P＜0.01］. After thyroxine treatment, the serum level of FT4 significantly increased (P=0.005) while the serum level of Cr significantly decreased (P=0.001). The serum Cr level was positively correlated with lnCK(P=0.032, r=0.596), and CCr was positively correlated with FT4(P=0.043, r=0.527). Conclusions　　Routine screening of thyroid function is recommended in patients with elevated serum Cr level. An increased serum Cr level is correlated with both the decrease of CCr and the damage of muscles. The level of serum Cr elevated due to hypothyroidism could return to normal range when the thyroid function recovers.