CAJ | 학술논문

目的对维持血液透析(MHD)患者的甲状腺功能和营养状态的关系进行分析.方法应用化学发光法检测54例MHD患者的甲状腺功能,并以16名年龄、性别相匹配的健康人群作为正常对照.分析人体测量指标、生化指标、微炎症指标超敏C反应蛋白(hs-CRP)和营养不良-炎症评分(MIS)的关系.结果 MHD组血清三碘甲状腺原氨酸(T3)[(1.18 ±0.31) nmol/L与(2.95±0.27) nmol/L]、游离三碘甲状腺原氨酸(FT3)[(2.61±0.62) pmol/L与(7.12±0.94) pmol/L]、血清四碘甲状腺原氨酸(T4) [(100.00±19.96) nmol/L与(136.25±19.68) nmol/L]、血清游离四碘甲状腺原氨酸(FT4)[(8.56±0.85) pmol/L与(8.89±0.56) pmol/L],均较对照组下降(P均＜0.01)；血清促甲状腺激素(TSH)变化不明显(P=0.058).按照白蛋白标准营养分级:MHD组营养不良患者39例,占75％ (39/54).MIS营养分级:54例MHD患者均存在营养不良,其中轻度营养不良16例(轻度组),占29.63％(16/54)；中度营养不良20例(中度组),占37.04％ (20/54)；重度营养不良18例(重度组),占33.33％(18/54).MHD患者轻度、中度、重度组MIS、血清白、血清肌酐、血红蛋白、血清铁、上臂围、体质量指数(BMI)、三角肌皮褶、hs-CRP、T3、FT3、T4、FT4、TSH比较差异均有统计学意义(P均＜0.01).54例MHD患者中,存在微炎症状态者32例,占59.26％ (32/54).FT3与白蛋白正相关,T3与血肌酐正相关(P＜0.01,P＜0.05)；甲状腺功能指标与hs-CRP、MIS负相关(P均＜0.01)；营养指标与hs-CRP、MIS负相关(P均＜0.01).结论甲状腺功能指标在某种程度上反映MHD患者的营养状态,而且均与微炎症相关；而MIS也是评判MHD患者营养不良-炎症状态的一种较好的指标.
목적 대유지혈액투석(MHD)환자적갑상선공능화영양상태적관계진행분석.방법 응용화학발광법검측54례MHD환자적갑상선공능,병이16명년령、성별상필배적건강인군작위정상대조.분석인체측량지표、생화지표、미염증지표초민C반응단백(hs-CRP)화영양불량-염증평분(MIS)적관계.결과 MHD조혈청삼전갑상선원안산(T3)[(1.18 ±0.31) nmol/L여(2.95±0.27) nmol/L]、유리삼전갑상선원안산(FT3)[(2.61±0.62) pmol/L여(7.12±0.94) pmol/L]、혈청사전갑상선원안산(T4) [(100.00±19.96) nmol/L여(136.25±19.68) nmol/L]、혈청유리사전갑상선원안산(FT4)[(8.56±0.85) pmol/L여(8.89±0.56) pmol/L],균교대조조하강(P균＜0.01)；혈청촉갑상선격소(TSH)변화불명현(P=0.058).안조백단백표준영양분급:MHD조영양불량환자39례,점75％ (39/54).MIS영양분급:54례MHD환자균존재영양불량,기중경도영양불량16례(경도조),점29.63％(16/54)；중도영양불량20례(중도조),점37.04％ (20/54)；중도영양불량18례(중도조),점33.33％(18/54).MHD환자경도、중도、중도조MIS、혈청백、혈청기항、혈홍단백、혈청철、상비위、체질량지수(BMI)、삼각기피습、hs-CRP、T3、FT3、T4、FT4、TSH비교차이균유통계학의의(P균＜0.01).54례MHD환자중,존재미염증상태자32례,점59.26％ (32/54).FT3여백단백정상관,T3여혈기항정상관(P＜0.01,P＜0.05)；갑상선공능지표여hs-CRP、MIS부상관(P균＜0.01)；영양지표여hs-CRP、MIS부상관(P균＜0.01).결론 갑상선공능지표재모충정도상반영MHD환자적영양상태,이차균여미염증상관；이MIS야시평판MHD환자영양불량-염증상태적일충교호적지표.
Objective To explore the correlation of the throid function and malnutrition in maintenance hemodialysis(MHD) patients.Methods Fifty-four MHD patients and 16 normal controls were enrolled as our subjects and named as MHD group and control group.Serum concentrations of total triiodothyronine (TT3),total thyroxine (TT4),free thyroine (FT4),free triiodothyronine (FT3),and thyroid-stimulating hormone (TSH) were measured by enhanced chemiluminescence immunoassay.Their anthropometry,biochemical assays,malnutrition-inflammation score (MlS) and micro-inflammation parameters such as high sensitivity C-reactiveprotein(hs-CRP) were also measured.Results Serum T3,FT3,T4,FT4 concentration in MHD patients were (1.18 ±0.31) nmol/L,(2.61 ±0.62) pmol/L,(100.00 ± 19.96) nmol/L,(8.56 ±0.85) pmol/L respectively,lower than that of control group ((2.95 ± 0.27) nmol/L,(7.12 ± 0.94) pmol/L,(136.25 ± 19.68) nmol/L,(8.89 ± 0.56) pmol/L respectively,P ＜ 0.01).while there was no significant change on TSH (P =0.058).According to albumin nutrient grading standard:the morbidity of malnutrition was 75％ (39/54).The morbidity of malnutrition was 100％ based on the criteria of MIS.Of which,mild malnutrition rate was 29.63％ (16/54),moderate rate for 37.04％ (20/54) and sever rate for 33％ (18/54).The levels of serum creatinine,hemoglobin,serum iron,upper arm circumference,body mass index(BMI),deltoid skinfold,hs-CRP,T3,FT3,T4,FT4,TSH in MHD patients with mild,moderate and serve rate MIS were significant different(P ＜ 0.01).Of 54 MHD patients,32 cases were with micro inflammatory state,accounting for 59.26％ (32/54).There was a positive correlation between FT3 and albumin (P ＜0.01).T3 was related to serum creatinine(P ＜ 0.05).Thyroid function parameters showed a negative correlation with hs-CRP,MIS(P ＜ 0.01).And a negative correlation was seen between nutrition indices and hs-CRP and MIS (P ＜ 0.01).Conclusion Thyroid function can reflect the nutrition status of MHD patients to some degree,and both relate with miro-inflammation.Furthermore,MIS is a useful index for the estimation of malnutrition inflammation status.