孙铭 刘叶伟 孙逸君 武文斌 于淑军

[摘要]目的 通過对血液透析（HD）及腹膜透析（PD）的尿毒症患者治疗前后血清游离三碘甲状腺原氨酸（FT3） 、游离甲状腺素（FT4）、促甲状腺激素（TSH）变化的分析，探讨两种不同血液净化方式对尿毒症患者甲状腺相关激素水平的影响。方法 选取2011年1月～2014年12月潍坊市益都中心医院及威海市中医院肾内科收治的108例尿毒症患者作为研究对象，根据患者及家属意愿分为HD组（59例）和PD组（49例），分别于开始进行透析前和透析6个月后清晨抽取静脉血，检测血清FT3、FT4、TSH的浓度。结果 HD组治疗前后的血清FT3、FT4、TSH水平比较，差异无统计学意义（P>0.05）；PD组治疗后的血清FT3水平明显高于治疗前，差异有统计学意义（P<0.01）；PD组治疗后的血清FT3水平高于HD组，差异有统计学意义（P<0.05）；PD组治疗后的血清FT4水平低于治疗前，差异有统计学意义（P<0.05），且PD组治疗后的血清FT4水平低于HD组，差异有统计学意义（P<0.05）；PD组治疗前后的血清TSH水平比较，差异无统计学意义（P>0.05）。结论 HD对尿毒症患者甲状腺相关激素水平没有明显的影响，PD可以使血清FT3的水平升高，在一定程度上减少低T3的危害，同时也带来FT4水平下降的问题，两种不同的治疗方法对甲状腺-垂体反馈回路无影响。

[关键词]血液透析；腹膜透析；尿毒症；甲状腺激素

[中图分类号] R581 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0067-03

[Abstract]Objective To investigate the changes of free triiodothyronine （FT3），free thyroxine （FT4），and thyroid stimulating hormone （TSH） in uremic patients undergone hemodialysis （HD） and peritonial dialysis （PD） to explore the influence of two different blood purification methods on thyroid related hormones.Methods From January 2011 to December 2014，108 patients in Department of Nephrology，Weifang Yidu Central Hospital and Weihai Traditional Chinese Medicine Hospital were selected as the subjects，and divided into HD group （59 cases） and PD group （49 cases） according to the patients′ and their families′ wills.The venous blood samples at the early morning were collected before dialysis and 6 months after dialysis in order to detect the concentrations of serum FT3，FT4，and TSH.Results There was no significant difference in FT3，FT4，and TSH levels between before and after treatment in HD group （P>0.05）.The level of serum FT3 in PD group after therapy was significantly higher than that before treatment，the difference was statistically significant （P<0.01）.After therapy，the level of serum FT3 in PD group was higher than that in HD group，the difference was statistically significant （P<0.05）.The level of serum FT4 in PD group was lower than that before treatment with a statistical difference （P<0.05）.The level of serum FT4 in PD group was lower than that in HD group after therapy （P<0.05）.For serum TSH levels between before and after treatment in PD group，no significant difference was displayed （P>0.05）.Conclusion HD has no significant effect on thyroid-related hormone levels in patients with uremia.PD can increase serum FT3，reduce the harm of T3 in low level to a certain extent，and also lead to a decrease of FT4.The two different therapeutic methods have no impact on thyroid-pituitary feedback circuit.

[Key words]Hemodialysis；Peritoneal dialysis；Uremia；Thyroid hormone

近年来随着血液净化技术的飞速发展，尿毒症患者的生存期及生存质量有了明显改善，但其远期并发症和病死率仍然较高，不同血液净化方式对尿毒症患者甲状相关腺激素水平的影响及机制众说纷纭，尚无定论[1-2]。本文观察对比了血液透析（HD）及腹膜透析（PD）患者甲状腺相关激素的变化，旨在探讨尿毒症患者不同血液净化方式对甲状腺相关激素水平的影响。

1资料与方法

1.1一般资料……