【摘要】目的探讨维持性腹膜透析(peritoneal dialysis,PD)患者低三碘甲状腺原氨酸(triiodothyronine, T3)综合征与残余肾功能及患者存活之间的关系。方法收集所有于2009 年4 月在北京大学第三医院接受维持性PD 治疗患者的人口学、甲状腺功能及临床生化学等资料，随访7 年。根据残余肾功能水平均分为3 组，比较临床特点。采用多元线性回归探讨影响血清游离T3(free T3,FT3)的因素和
COX 比例风险模型分析血清FT3 对患者生存的影响。结果本研究共纳入125 例研究对象，其中表现为低T3 综合征34 例(27.2%)。残余肾功能最高组的血清FT3 高于其他2 组(F=12.779,P＜0.001)，低T3综合征发生率最低(χ2=10.175,P=0.038)，为14.3%。单因素分析显示血清FT3 与残余肾每周尿素清除率(renal Kt/V,rKt/V)(r=0.270, P=0.002)、蛋白氮呈现率(protein equivalent of nitrogen appearance, PNA) (r=0.217,P=0.016)、血红蛋白(hemoglobin,HGB) (r=0.183,P =0.044)及血清白蛋白(albumin, ALB) (r=0.424,P＜0.001)呈正相关，而与年龄(r=-0.346,P＜0.001)、血清C 反应蛋白(C-reactive protein,CRP)(r=-0.311,P＜0.001)呈负相关。多元线性回归分析显示在校正性别、年龄、ALB、血清CRP、HGB 及PNA 后，rKt/V 仍是影响血清FT3 的独立因素(β=0.284, P=0.004)，而COX 回归分析显示在校正性别、年龄、rKt/V、PNA、HGB、以及血清CRP 和ALB 等因素后，血清FT3 仍能独立地预测患者的生存(HR: 0.303,95% CI:0.103～0.889,P=0.030)。结论笔者研究表明在维持性PD 人群中，低T3 综合征的发生与残余肾功能密切相关，血清FT3水平能独立预测患者的死亡风险。
【Abstract】Objective To examine the correlation of low triiodothyronine (T3) syndrome with residual renal function and survival in patients undergoing maintenance peritoneal dialysis (PD). Methods Baseline data including thyroid hormone tests were recruited from PD patients treated in our Hospital in April 2009, and a seven- year follow- up was conducted. The relationship between serum free T3 (FT3) and renal Kt/V (rKt/V) was explored using one-way ANOVA and linear regression analysis, and Cox proportional hazards modeling was used to explore the association between serum FT3 and all-cause mortality. Results A total of
125 subjects were included in this study, of whom 34 patients (27.2%) presented with low T3 syndrome. In the patients with the highest rKt/V, serum FT3 was higher (F=12.779, P<0.001) and the prevalence of low T3 syndrome was the lowest (14.3%, χ2=10.175, P=0.038) as compared with the other two groups. Univariate regression analysis revealed that the level of serum FT3 was positively correlated with rKt/V (r=0.270, P=0.002), protein equivalent of nitrogen appearance (PNA) (r=0.217, P= 0.016), hemoglobin (HGB) (r=0.183, P=0.044) and serum albumin (ALB) (r=0.424, P<0.001), and was negatively correlated with serum C-reactive protein (CRP) (r=-0.311, P<0.001) and age (r=-0.346, P<0.001). Multivariate regression analysis showed that rKt/V remained the independent influencing factor on serum FT3 level after adjusting sex, age, serum ALB, CRP, HGB and PNA (β=0.284, P=0.004). Cox regression analysis showed that serum FT3 remained to be an independent predict factor for all-cause mortality in PD patients after adjusting sex, age, HGB, PNA, serum ALB, CRP and rKt/V (HR 0.303, 95% CI 0.103～0.889, P=0.030). Conclusions Our study demonstrates that the presence of serum FT3 syndrome is closely associated with residual renal function and that serum FT3 can independently predict death risk in PD patients.
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