目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者焦虑状态和血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)的关系。 方法 单中心横断面研究。纳入2021年9月在暨南大学附属广州红十字会医院血液净化中心行MHD的患者。收集受试者的人口学、临床资料和问卷资料，测定透析前血常规、血清生化指标和血清FT3，根据汉密尔顿焦虑量表(Hamilton anxiety scale，HAMA)评分将患者分为非焦虑状态组(总分＜7分)和焦虑状态组(总分≥7分)，比较2组的临床特征，应用二元Logistic回归评价与MHD患者焦虑状态相关的因素，使用易侕(empower stats 3.0)软件分析变量间的因果中介效应。 结果 共纳入120例MHD患者，其中焦虑状态组66例，非焦虑状态组54例，spearman相关分析提示血清FT3水平与睡眠评分呈负相关(r=-0.277，P=0.002)。在校正相关混杂因素后，多因素二元Logistic回归显示血清低FT3水平和焦虑状态相关(OR=3.167，95% CI：1.144～8.772，P=0.027)；将睡眠评分纳入时，FT3和焦虑状态的独立关联消失(OR=0.842，95% CI：0.812～8.051，P= 0.109)。中介效应分析显示血清FT3和焦虑状态的关联中，有47.6%的效应占比是通过睡眠的变化达成的(P=0.004)。 结论 MHD患者血清 FT3 水平与睡眠质量、焦虑三者之间存在密切联系，在血清FT3和焦虑状态的关联中，有47.6%的效应是通过睡眠的变化达成的。
Objective To investigate the relationship between serum FT3 level and anxiety state in maintenance hemodialysis (MHD) patients. Methods This was a single-center and cross-sectional study. Patients who underwent MHD in our center in September 2021 were enrolled. Demographic data, routine blood biochemical examination, and serum free triiodothyronine (FT3) before dialysis sessions were tested, and the anxiety status of the patients was evaluated by the Hamilton Anxiety Scale (HAMA). According to the anxiety scale score, patients were divided into the without anxiety status group (total score＜7 points) and with anxiety status group (total score≥7 points). Multivariate binary Logistic regression was used to analyze the independent factors associated with anxiety risk, and software (Empower Stats 3.0) was used to analyze causal mediating effects among variables. Results A total of 120 MHD patients were enrolled in this study, including 66 patients in the anxiety status group and 54 patients in the control group. Spearman analyses showed that the levels of serum FT3 negatively correlated with the sleep score (r=-0.277, P=0.002). Multivariate binary logistic regression analysis showed that low serum FT3 level in MHD patients in our center was independent associated with anxiety status (OR=3.167，95% CI：1.144～8.772, P=0.027), but when sleep score was included in the models, the association between the serum FT3 and anxiety status disappeared (OR=0.842，95% CI：0.812～8.051, P=0.109). Mediation analysis showed that 47.6% of the effect of serum FT3 on anxiety state was mediated through sleep disturbance (P=0.004).
[1].参考文献
[2]肖雪, 施素华, 王培莉, 等.维持性血液透析患者焦虑、抑郁与透析充分性的相关调查[J].中国中西医结合肾病杂志, 2021, 22(04):321-322
[3]Schouten R W, Haverkamp G L, Loosman W L, et al.Anxiety Symptoms,Mortality,and Hospitalization in Patients Receiving Maintenance Dialysis: A Cohort Study[J].Am J Kidney Dis, 2019, 74(2):158-166
[4]Narasaki Y, Sohn P, Rhee C M.The Interplay Between Thyroid Dysfunction and Kidney Disease[J].Semin Nephrol, 2021, 41(2):133-143
[5]何萍, 毛慧娟.慢性肾脏病患者甲状腺功能与心血管疾病相关性的研究进展[J].临床肾脏病杂志, 2015, 13(7):443-446
[6]Fitzgerald S P, Bean N G, Falhammar H, et al.Clinical Parameters Are More Likely to Be Associated with Thyroid Hormone Levels than with Thyrotropin Levels: A Systematic Review and Meta-Analysis[J].Thyroid, 2020, 30(12):1695-1709
[7]Qiao D, Liu H, Zhang X, et al.Exploring the potential of thyroid hormones to predict clinical improvements in depressive patients: A machine learning analysis of the real-world based study[J].J Affect Disord, 2022, 299:159-165
[8]Taroza S, Rastenyte D, Burkauskas J, et al.Lower serum free triiodothyronine levels are associated with symptoms of depression after ischemic stroke[J].J Psychosom Res, 2019, 122:29-35
[9]周林平, 田信奎.老年腹膜透析患者综合征与低综合征之间的关系[J].广州医学院学报, 2012, 40(3):18-21
[10]Gao J, Xu Y, Kong D, et al.Association of triiodothyronine levels with left ventricular function,cardiovascular events,and mortality in hemodialysis patients[J].Int J Artif Organs, 2017, 40(2):60-66
[11]Yavuz D, Sezer S, Yavuz R, et al.Free triiodothyronine in hemodialysis patients: link with malnutrition and inflammation[J].Iran J Kidney Dis, 2014, 8(3):212-217
[12]Saito O, Saito T, Ueno K, et al.Comparison between serum free triiodothyronine levels and body fluid distribution in hemodialysis patients[J].Clin Exp Nephrol, 2012, 16(6):952-958
[13]Imai K, Keele L, Tingley D.A general approach to causal mediation analysis[J].Psychol Methods, 2010, 15(4):309-334
[14]张兰, 孙超, 程艳娇, 等.维持性血液透析患者心理和认知功能调查及其影响因素分析[J].中国血液净化, 2019, 18(2):107-109
[15]刘振静, 王珣, 宋欣欣, 等.女性焦虑障碍患者家庭环境、生活事件及甲状腺激素水平的分析[J].临床精神医学杂志, 2018, 28(5):355-357
[16]杨志慧, 裴清华, 卢美枚, 等.广泛性焦虑障碍与甲状腺激素水平的相关性研究[J].中国医药导报, 2021, 18(14):199-122
[17]赵子然.甲状腺功能异常对焦虑、抑郁情感及生活质量的影响[D]., 2014.
[18]Wang S, Su M L, Zhang Y, et al.Role of N-methyl-d-aspartate receptors in anxiety disorder with thyroid lesions[J].J Psychosom Res, 2022, 161:-
[19]Zhou J J, Gao Y, Zhang X, et al.Enhanced Hypothalamic NMDA Receptor Activity Contributes to Hyperactivity of HPA Axis in Chronic Stress in Male Rats[J].Endocrinology, 2018, 159(3):1537-1546
[20]Rebola N, Srikumar B N, Mulle C.Activity-dependent synaptic plasticity of NMDA receptors[J].J Physiol, 2010, 588(Pt 1):93-99
[21]Grova N, Schroeder H, Farinelle S, et al.Sub-acute administration of benzo[a]pyrene (B[a]P) reduces anxiety-related behaviour in adult mice and modulates regional expression of N-methyl-D-aspartate (NMDA) receptors genes in relevant brain regions[J].Chemosphere, 2008, 73(1 Suppl):S295-S302
[22]Huang H Y, Liao H Y, Lin Y W.Effects and Mechanisms of Electroacupuncture on Chronic Inflammatory Pain and Depression Comorbidity in Mice[J].Evid Based Complement Alternat Med, 2020, 2020:-
[23]Green M E, Bernet V, Cheung J.Thyroid Dysfunction and Sleep Disorders[J].Front Endocrinol (Lausanne), 2021, 12:-
[24]温国花, 祝建辉, 赵文, 等.个性化护理干预对慢性肾脏病患者不良情绪、睡眠质量及生活质量的影响[J].中国临床护理, 2017, 9(3):203-206
