目的 探讨维持性血液透析(maintenance hemodialysis，MHD)患者睡眠障碍与甲状腺功能之间的关系。 方法 采用单中心横断面研究，纳入2023年11月在暨南大学附属广州红十字会医院血液净化中心规律行MHD的患者。收集患者的一般资料、透析前血液检查资料、用药情况，并收集患者透析前血清以检测甲状腺功能相关指标，以匹兹堡睡眠质量指数(Pittsburgh sleep quality index，PSQI)量表评估患者睡眠质量。 结果 共纳入患者126例，其中睡眠正常组65例(51.6%)，睡眠障碍组61例(48.4%)。单因素二元Logistic回归分析显示，连续变量中较低的血清游离三碘甲状腺原氨酸(FT3)水平(OR=0.332，95% CI: 0.178～0.620，P=0.001)、较长的透析龄(OR=1.018，95% CI:1.007～1.030， P=0.001)，以及分类变量中FT3＜3.4 pmol/L(OR=3.201，95% CI:1.222～8.390，P=0.018)、服用安眠药物(OR=5.658，95% CI:2.310～13.861，P＜0.001)均与睡眠障碍相关。血清游离四碘甲状腺原氨酸、促甲状腺激素水平和睡眠障碍的关联无统计学意义。在多因素二元Logistic回归中，调整了年龄、性别、透析龄、Kt/V、服用安眠药物后，发现血清FT3＜3.4 pmol/L与睡眠障碍仍然相关(OR=3.225，95% CI:1.229～8.464，P=0.017)。 结论 MHD患者较低的血清FT3和睡眠障碍独立相关，但两者的关联仍需前瞻性研究进一步确认。
Objectives To investigate the association between sleep disturbance and thyroid function in maintenance hemodialysis (MHD) patients. Methods This was a single-center and cross-sectional study. Patients regularly undergoing maintenance hemodialysis at the Blood Purification Center in Guangzhou Red Cross Hospital of Jinan University in November 2023 were enrolled. Demographic data, pre-dialysis laboratory parameters, medication history were collected, and pre-dialysis serum samples were collected for thyroid function tests. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results In total, 126 patients were enrolled, with 65 (51.6%) patients in the normal sleep group and 61 (48.4%) patients in the sleep disturbance group. Univariate binary logistic regression showed that continuous variables including lower serum free triiodothyronine (FT3) levels (OR=0.332,95% CI:0.178～0.620, P=0.001) and longer dialysis vintage (OR=1.018, 95% CI:1.007～1.030,P=0.001), as well as categorical variables including FT3 ＜3.4 pmol/L (OR=3.201,95% CI:1.222～8.390, P=0.018) and use of sleep medications (OR=5.658,95% CI:2.310～13.861,P＜0.001) were all associated with sleep disturbance. However, there was no significant association between serum free thyroxine, thyroid-stimulating hormone levels, and sleep disturbance. After adjusted for age, sex, dialysis vintage, Kt/V, and use of sleep medications, the multivariate binary logistic regression showed serum FT3＜3.4 pmol/L (OR=3.225，95% CI:1.229～8.464，P=0.017) was still associated with sleep disturbance. Conclusion Lower serum FT3 levels and sleep disturbance were independently associated in MHD patients. However, prospective studies are needed to confirm the results.
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