CAJ | 학술논문

目的：回顾性分析慢性肾衰竭非透析患者心脏功能及甲状腺功能的变化，并探讨其中的关系。方法：采用横断面研究的方法，取慢性肾衰竭患者70例以MDRD法及胱抑素C(cystatin C，cyc C)法评估肾小球滤过率(glomerular filtration rate，eGFR)，根据eGFR分成2组，≥30 mL·min-1·(1.73 m2)-1为A组，<30 mL·min-1·(1.73 m2)-1为B组，收集患者临床资料和生化指标与甲状腺功能，心脏超声检查测量心脏腔径及心功能参数。分析各组之间的心脏结构及功能与甲状腺激素之间的关系。结果：B组促甲状腺激素(thyroid stimulating hormone，TSH)、左心室重量指数较A组升高；多元线性回归提示eGFR与左心室重量指数呈负相关(β=-0.32，P<0.01)；在左室肥厚研究对象中多元线性回归提示游离三碘甲状腺原氨酸(free triiodothyronine，FT3)与左心室重量指数呈负相关(β=-2.83，P<0.01)；与MDRD法相比，利用cyc C评估肾功能预测心脏结构异常有优势，但在甲状腺功能异常者利用eGFR(MDRD)评估更有优势。结论：慢性肾衰竭随着肾功能减退，左心室重量指数及TSH升高。在慢性肾衰竭左室肥厚患者中，随着FT3的减低，左心室重量指数升高。
목적：회고성분석만성신쇠갈비투석환자심장공능급갑상선공능적변화，병탐토기중적관계。방법：채용횡단면연구적방법，취만성신쇠갈환자70례이MDRD법급광억소C(cystatin C，cyc C)법평고신소구려과솔(glomerular filtration rate，eGFR)，근거eGFR분성2조，≥30 mL·min-1·(1.73 m2)-1위A조，<30 mL·min-1·(1.73 m2)-1위B조，수집환자림상자료화생화지표여갑상선공능，심장초성검사측량심장강경급심공능삼수。분석각조지간적심장결구급공능여갑상선격소지간적관계。결과：B조촉갑상선격소(thyroid stimulating hormone，TSH)、좌심실중량지수교A조승고；다원선성회귀제시eGFR여좌심실중량지수정부상관(β=-0.32，P<0.01)；재좌실비후연구대상중다원선성회귀제시유리삼전갑상선원안산(free triiodothyronine，FT3)여좌심실중량지수정부상관(β=-2.83，P<0.01)；여MDRD법상비，이용cyc C평고신공능예측심장결구이상유우세，단재갑상선공능이상자이용eGFR(MDRD)평고경유우세。결론：만성신쇠갈수착신공능감퇴，좌심실중량지수급TSH승고。재만성신쇠갈좌실비후환자중，수착FT3적감저，좌심실중량지수승고。
Objective:To investigate the changes of cardiovascular disorder and thyroid function, to explore the relationship in non-dialysis patients with chronic renal failure (CRF). Methods: A total of 70 cases in patients with CRF were enrolled in the retrospective study. The patients were divided into group A and group B by estimated glomerular filtration rate (MDRD) (eGFR) ≥30, <30 mL·min-1·(1.73 m2)-1. Clinical data, biochemical indicators and thyroid function were collected. Cardiac ultrasound measurement of cardiac lumen diameter parameters and function were assessed by echocardiography. The associations between the changes of cardiac structure and function with thyroid function were analyzed in different stages of eGFR. Results: In group B serum thyroid stimulating hormone(TSH), Left ventricular mass index were significantly higher than group A. The prevalence of high value in TSH was significant higher in group B(P=0.03). Linear regression analysis revealed that there was a negative correlation between eGFR measured by serum creatinine and cystatin C and left ventricular mass index(β=-0.32,P<0.01). In the patients with left ventricular hypertrophy, a negative correlation between free triiodothyronine ( FT3 ) and left ventricular mass index was observerd (β=-2 . 83 , P<0 . 01 ) . eGFR measured by serum creatinine and cystatin C was superior to eGFR measured by serum creatinine in assessing the cardiovascular disorder in different stages of kidney function, but inferior in assessing thyroid function in different stages of kidney function. Conclusions: Reduced kidney function associates with increased left ventricular mass index and higher TSH in non-dialysis patients with chronic renal failure. In the left ventricular hypertrophy patients of those , FT3 is negatively correlated to the left ventricular mass index. The mechanism should be further researched.