肾病综合征伴甲状腺激素水平异常患者临床病理分析

目的检测肾病综合征（nephroticsyndrome，NS）患者的甲状腺激素（TH）水平，探讨NS伴TH异常者的临床特点及病理分布。方法选择符合NS诊断标准且既往无甲状腺相关疾病史的患者143例，所有患者均测定TH并进行肾活检，分析总结其临床特点、病理类型分布及与足细胞病的相关性等。结果①143例NS患者中，TH水平正常者34例（TH正常组），TH水平异常者109例（TH异常组），其中非甲状腺疾病综合征96例，自身免疫性甲状腺疾病13例，桥本氏甲状腺炎11例，甲状腺功能减退症1例，Graves甲状腺功能亢进1例。②TH正常组24h尿蛋白定量明显低于TH异常组，白蛋白水平明显高于TH异常组，总胆固醇水平明显低于TH异常组。③TH异常组中，白蛋白水平与血清游离三碘甲状腺原氨酸（FT3）、血清游离甲状腺素（FT4）水平呈正相关（r=0．551、0．642，P〈0．01），与促甲状腺激素（TSH）水平呈负相关（r=-0．251，P〈0．01）。总胆固醇水平与FT4呈负相关（r=-0．427，P〈0．01）、与TSH（r=0．289，P〈0．01）呈正相关，与FT3无相关性。④109例NS并TH水平异常患者肾活检病理显示，系膜增生性肾炎43例，膜性肾病40例，IgA肾病9例，膜增生性肾小球肾炎4例，局灶节段硬化性肾小球肾炎11例，微小病变肾病2例。表现为足细胞病者56例、非足细胞病53例，两者间TH水平差异无统计学意义（P〉0．05）。结论①NS患者临床易合并TH异常，表现以非甲状腺疾病综合征为主，自身免疫性甲状腺疾病次之。②NS合并TH异常者比正常者临床表现更突出。③NS合并TH异常者病理以系膜增生性肾炎、膜性肾病多见。其表现为足细胞病者与非足细胞病者病例数相当。

Clinicopathological analysis of nephrotic syndrome with abnormal levels of thyroid hormone

Objective To analyze the clinical features and pathological types in nephrotic syn- drome （NS） with abnormal levels of thyroid hormone （TH） in recent years. Methods 143 cases of NS in accordance with the NS diagnosis criteria without history of thyroid diseases were collected from 2010 to 2012. TH levels were determined and renal biopsy was done on all patients. The clinical data of 143 patients with NS were analyzed. Results （1） There were 34 cases with normal levels of TH （con- trol group）, and 109 cases with abnormal levels of TH （experimental group） including 96 cases of non-thyroid illness syndrome （NTIS）, 13 cases of autoimmune thyroid disease （AITD）]. In 13 cases of NTIS, there were 11 cases of Hashimoto＇s thyroiditis, 1 case of hypothyroidism and 1 case of Graves hyperthyroidism; （2）24-h urinary protein was significantly lower, plasma albumin levels were signifi- cantly higher, and cholesterol levels were significantly lower in control group than in experimental group; （3）In experimental group, albumin was positively correlated with FT3 （r = 0. 551, P〈0. 01）, FT4 （r= 0. 642,P〈0. 01） and TSH （r= - 0. 251 ,P〈0. 01） ,andt cholesterol was negatively associated with FT4 （r = - 0. 427, P〈0. 01）, but positively with TSH （r = 0. 289, P〈0. 01） ; （4） In experimental group, there were 43 cases of MsPGN,40 cases of MN,9 cases of IgAN,4 cases of MPGN, 11 cases ofFSGS and 2 cases of MCD. There were 56 cases of podocytopathies and 53 cases of non-podocytopa- thies in experimental group. The levels of serum albumin were lower, and the levels of cholesterol were higher in podocytopathies group than in non-podocytopathies group. The levels of urinary protein and TH in the two groups had no significant difference. Conclusions （1） Patients with NTIS accounted for 67. 13 % in this study. The proportion of AITD-associated nephropathy with NS accounted for 9. 1%of all medical records; （2）The experimental group had more urinary protein secretion, lower albumin and higher cholesterol levels than in control group. The levels of TH can be used as an indicator to evaluate the clinical conditions of NS; （3）NS with abnormal level of TH, mesangial proliferative glomerulone- phritis and membranous nephropathy were more common. The number of podoeytopathies and non- podoeytopathies was very close.