慢性肾功能衰竭患者血清甲状腺激素水平与血脂代谢关系的临床探讨

目的探讨慢性肾功能衰竭（CRF）患者血清甲状腺激素水平的变化对血脂代谢的影响及其临床意义。方法采用放射免疫法（RIA）检测56例CRF患者和35名正常对照者血清总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、高敏促甲状腺素（h-TSH）的含量，同时测定其血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A-Ⅰ（apo A-Ⅰ）、载脂蛋白B（apo B）及肌酐（Cr）、β2微球蛋白（β2-MG）和白蛋白（A1b）等，并分析各指标的相关性。结果CRF患者血清TT3、FT3显著低于对照组（P〈0．01），TT4、FT4、h-TSH虽低于对照组，但差异无统计学意义（P〉0．05）；血清TG、LDL-C和apo B显著高于对照组（P〈0．01、P〈0．05、P〈0．05），HDL-C明显低于对照组（P〈0．05），TC和apo A-Ⅰ虽略高于对照组，但无统计学意义（P〉0．05）；血清Cr、β2-MG明显高于对照组（P〈0．01），A1b明显低于对照组（P〈0．01）。直线回归和相关性分析显示，CRF患者血清TT3、FT3均分别与Cr、TG、LDL-C、apo B呈显著负相关（P〈0．01），而与HDL-C呈显著正相关（P〈0．01），h-TSH与Cr、TG、HDL-C、LDL-C和apo B均无显著相关性（P〉0．05）。结论血清甲状腺激素水平降低与肾功能损害程度密切相关，与CRF患者血脂代谢紊乱有一定的关系。因此，CRF患者血清甲状腺激素水平的监测具有一定的临床价值。

Studies on the correlation between the level of serum thyroid hormone and lipid metabolism in patients with chronic renal failure

Objective To investigate the effect of the change of serum thyroid hormone level on the lipid metabolism in patients with chronic renal failure （CRF）, Methods The levels of serum total triiodothyronine（ TT3 ） , total thyroxine（ TT4 ） ,free triiodothyronine（ FT3 ） ,free thyroxine（ FT4 ）, and higher-thyrotropin（h-TSH） in 56 CRF patients and 35 healthy controls were measured by radioimmunoassay （ RIA ） , and serum total cholesterol （TC） , triglycerides （TG） , high density lipoprotein cholesterol（ HDL-C ）, low density lipoprotein cholesterol （ LDL-C ）, apolipoprotein A- Ⅰ（ apo A- Ⅰ） , apolipoprotein B （ apo B） , creatinine （Cr） , β2 -microglobulin （β2-MG） , albumin （A1b） concentrations were also determined ; and the correlation of these data was analyzed. Results The levels of TT3 and FT3 in patients with CRF were significantly lower than control group（ P 〈 0.01 ） , the levels of TT4, FT4 , h-TSH in CRF patients were decreased, but there was no difference with the control group（P 〉 0.05 ）. The levels of TG, LDL-C, apo B in patients with CRF were significantly higher than control group（ P 〈 0.01 , P 〈 0.05, P 〈 0.05 ）. The serum HDL-C in CRF patient was significantly lower than control group （P 〈 0.05 ） , but the levels of TC and apo A-Ⅰ were not different with control group（ P 〉 0.05 ）. The levels of Cr, β2- MG in CRF patient were significantly higher than control group （ P 〈 0.01 ）, and the serum Alb in CRF patient was significantly lower than control group （ P 〈 0.01 ）. There were negative correlation between TT3 , FT3 and Cr , TG,LDL-C and apo B（ P 〈 0.01 ） , positive correlation between TT3 , FT3 and HDL-C. Cr, TG, HDL-C, LDL-C and apo B were not correlated with h-TSH. Conclusions There is significant correlation between decrease of the serum level of thyroid hormone and the degree of kidney function lesion. There is correlation between serum thyroid hormone deficiency and blood lipid leve