维持性血液透析患者甲状腺功能、同型半胱氨酸与心血管病变的关系

 目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者甲状腺功能指标、同型半胱氨酸(homocysteine,Hcy,Hcy)水平与心功能和颈动脉病变的关系。方法 选取2017-01至2018-12在医院行MHD治疗的患者70例,透析时间3个月以上;所有病例透析前检测血常规、糖化血红蛋白、血脂、钙、磷、甲状腺功能指标游离三碘甲状腺原氨酸(FT₃)、游离甲状腺素(FT₄)、促甲状腺素(TSH)]及血清Hcy水平;采用超声检查颈动脉病变情况,超声心动图测定患者心功能指标。结果 所有70例MHD患者中,甲状腺功能异常者31例,占44.29%,51例(72.86%)血清Hcy水平高于正常值,39例(55.71%)患者伴有左心室肥厚,28例(40.00%)患者存在颈动脉粥样硬化表现;多因素Logistic回归分析提示FT₃降低、Hcy升高是MHD患者左心室肥厚的独立危险因素(均P<0.05);LDL-C升高、FT₃降低、Hcy升高是MHD患者颈动脉粥样硬化的独立危险因素(均P＜0.05)。结论 MHD患者多伴有甲状腺功能和血清Hcy水平异常,主要表现为FT₃降低及Hcy水平升高,且FT₃降低、Hcy升高与左心室肥厚、颈动脉粥样硬化密切相关。

Relationships between thyroid function,Hcy and cardiovascular disease in patients undergoing maintenance hemodialysis

Objective To explore the relationships between thyroid function indexes and homocysteine (Hcy) levels on one hand and cardiac function and carotid artery lesions on the other hand in patients undergoing maintenance hemodialysis (MHD).Methods Seventy patients who underwent MHD in the hospital between January 2017 and December 2018 were enrolled, who had been undergoing dialysis for more than three months. Before dialysis, all the patients were tested for blood routine, glycosylated hemoglobin, blood lipids, calcium, phosphorus, thyroid function indexes free triiodothyronine (FT₃), free thyroxine (FT₄), thyroid stimulating hormone (TSH)] and serum Hcy levels. Ultrasound examination was conducted for carotid artery lesions. Echocardiograms were used to determine cardiac function indexes.Results Among the 70 patients undergoing MHD, there were 31 cases with thyroid dysfunction that accounted for 44.29%, 51 cases (72.86%) with serum Hcy levels higher than the normal value, 39 cases (55.71%) with left ventricular hypertrophy, and 28 cases (40.00%) with carotid atherosclerosis. Multivariate Logistic regression analysis showed that elevated FT₃ and decreased Hcy were independent risk factors for left ventricular hypertrophy in patients undergoing MHD (P<0.05). The increase of LDL-C, decrease of FT₃ and elevation of Hcy were independent risk factors for carotid atherosclerosis (P<0.05).Conclusions MHD patients are usually accompanied by abnormal thyroid function and serum Hcy levels, such as the decrease of FT₃ and increase of Hcy levels, which are closely related to left ventricular hypertrophy and carotid atherosclerosis.