慢性肾脏病合并甲状腺功能减退患者应用左甲状腺激素替代治疗的临床意义

尹敏,张芝平,刘锋.慢性肾脏病合并甲状腺功能减退患者应用左甲状腺激素替代治疗的临床意义[J].吉林医学,2014,35(2):258-260.

慢性肾脏病；估算的肾小球滤过率；甲状腺功能减退；左甲状腺激素替代治疗

尹敏,张芝平,刘锋

(吉林大学中日联谊医院,吉林长春130033）

2014年

258-260.

知网,万方

目的：研究在适当的左甲状腺激素替代治疗后,能否逆转或延缓慢性肾脏病进展。方法：根据eGFR将CKD分为CKD2期组、CKD3期组、CKD4期组。分别比较治疗前后的患者TSH、FT3、FT4、eGFR的变化。再将每组患者根据甲状腺功能分为：a、b两个亚组进行比较。结果：①CKD4期组患者年龄明显大于其余两组；CKD4期组患者TSH明显高于其余两组,FT3、FT4明显低于其他两组。CKD2期组治疗后,eGFR改善不显著；CKD3及CKD4期组治疗后,eGFR显著改善。②分为a、b亚组进行分析。将CKD2a、CKD2b、CKD3a、CKD3b、CKD4a、CKD4b：其中CKD2b、CKD4b组患者治疗后,eGFR改善不显著；CKD2a、CKD3a、CKD3b、CKD4a组患者治疗后,eGFR均显著改善。无论CKD2期、CKD3期及CKD4期组患者,存在明显甲状腺功能减退的患者比亚临床甲状腺功能减退的患者eGFR改善更明显。结论：①CKD合并甲状腺功能减退的患者,经左甲状腺激素替代治疗两个月后,甲状腺功能均显著改善；②CKD3期组和CKD4期组患者经左甲状腺激素替代治疗后,eGFR改善较治疗前均有显著差异；③三组患者治疗前后eGFR的变化（即ΔeGFR）,其中CKD3期组患者最为显著；④经左甲状腺激素替代治疗两个月后,临床甲状腺功能减退亚组较亚临床甲状腺功能减退亚组的甲状腺功能及eGFR改善更为显著。 ObjectiveBy studying whether the kidney disease progression can be reversed or delayed after the appropriate thyroid hormone replacement therapy.MethodsAccording to eGFR,CKD patients were divided into CKD 2 Group ,CKD 3 Group and CKD 4 Group.Then,variation in TSH,FT3,FT4 and eGFR before and after the treatment was compared.Next,the two groups were further divided into Subgroup A and B according to the degree of thyroid dysfunction.Comparison was made between the two subgroups.Results⑴The age in CKD4 is more older,The serum TSH level in the CKD 3 Group was significantly higher than that of the CKD 2 Group.No significant eGFR improvement was found in patients of the CKD 2 Group after they received levothyroxine therapy.⑵CKD 2 Group and CKD 3 Group were further divided into Subgroup A and Subgroup B for analysis according to the degree of thyroid dysfunction.No significant eGFR improvement was found in patients of the CKD2b Group after the application of levothyroxine therapy; significant eGFR improvement was found in patients of the CKD2a Group,the CKD3a Group and the CKD3b Group after the application of levothyroxine therapy.For both the CKD 2 Group and the CKD 3 Group,more significant eGFR improvement was found in patients with hypothyroidism than in patients with subclinical hypothyroidism after the application of levothyroxine therapy.Conclusion①For CKD patients with hypothyroidism,their thyroid function was significantly improved; ②significant eGFR improvement was found in patients of the CKD 3 Group after the application of levothyroxine replacement therapy;③The changes of ΔeGFR in the CKD3 group is the most significant;④More significant eGFR improvement was found in the clinical hypothyroidism group than in the subclinical hypothyroidism group.Higher degree of thyroid dysfunction has greater impact on eGFR in CKD patients.。