2020 年第 7 期 第 15 卷

血液透析患者低三碘甲状腺原氨酸综合征与代谢性酸中毒的相关性研究

Relation between low hypotriiodothyronine syndrome and metabolic acidosis in hemodialysis patients

作者：李晓帆1周晓霜2薄天慧1李峻岭1赵海丹1

英文作者：Li Xiaofan1 Zhou Xiaoshuang2 Bo Tianhui1 Li Junling1 Zhao Haidan1

单位：1北京大学首钢医院肾内科100041；2山西省人民医院肾内科，太原030012

英文单位：1Department of Nephrology， Peking University Shougang Hospital， Beijing 100041， China； 2Department of Nephrology Shanxi Provincial People′s Hospital Taiyuan 030012 China

关键词：低三碘甲状腺原氨酸综合征；代谢性酸中毒；血液透析；血清碳酸氢钠

英文关键词：LowT3syndrome；Metabolicacidosis；Hemodialysis；Sodiumbicarbonate

• 摘要：

• 目的探讨血液透析患者低三碘甲状腺原氨酸（T3）综合征与代谢性酸中毒的相关性。方法选取2017年9月至2018年9月北京大学首钢医院长期维持性血液透析的患者151例，根据T3水平将其分为正常T3组(77例)和低T3综合征组 ［74例，血清游离T3（FT3）＜3.5 pmol/L，游离甲状腺素正常且血清促甲状腺激素＜4.5 mIU/L］，比较2组患者的血清碳酸氢根水平及其他生化指标，分析血液透析患者低T3综合征与代谢性酸中毒的相关性。结果低T3综合征组患者的血红蛋白、血清白蛋白、二氧化碳结合力（CO2CP）均低于正常 T3 组［(93±9)g/L比(110±9)g/L、(32±3)g/L比(39±4)g/L，(15.6±2.5)mmol/L比（21.2±5.8）mmol/L］，差异均有统计学意义(均P＜0.01)。低T3综合征组的总胆固醇明显高于正常T3组,差异有统计学意义［(5.1±0.9)mmol/L比(4.0±0.8)mmol/L,P＜0.01］。Pearson相关分析结果显示，CO2CP与FT3水平呈正相关（r=0.495,P＜0.001)，与总胆固醇、C反应蛋白以及校正血钙、血磷水平无明显相关性（r=-0.091、0.202、0.048、0.200，P=0.831、0.373、0.673、0.343）。结论在维持性血液透析的患者中，CO2CP与FT3呈正相关，血清碳酸氢根水平越低，FT3水平越低。

• ObjectiveTo investigate the correlation between hypotriiodothyronine (T3) syndrome and metabolic acidosis in hemodialysis patients. Methods A total of 151 patients with long-term maintenance hemodialysis from September 2017 to September 2018 in Peking University Shougang Hospital were divided into normal T3 group (77 cases) and low T3 syndrome group ［74 cases, serum free T3 (FT3)＜3.5 pmol/L, free thyroxine is normal and serum thyroid stimulating hormone is＜4.5 mIU/L］ according to T3 level. The serum bicarbonate level and other biochemical indicators of the two groups of patients were compared； the correlation between low T3 syndrome and metabolic acidosis in hemodialysis patients were analyzed. Results  The hemoglobin, serum albumin and carbon dioxide binding power of patients in the low T3 syndrome group were lower than those in the normal T3 group［(93±9)g/L vs (110±9)g/L, (32±3)g/L vs (39±4)g/L, (15.6±2.5)mmol/L vs (21.2±5.8)mmol/L］； the difference was statistically significant (all P＜0.01). Total cholesterol in the low T3 syndrome group was significantly higher than that in the normal T3 group； the difference was statistically significant ［(5.1±0.9)mmol/L vs (4.0±0.8)mmol/L, P＜0.01］. Pearson correlation analysis showed that there was a positive correlation between carbon dioxide binding force and FT3 (r=0.495, P＜0.05)； there was no significant correlation among total cholesterol, C-reactive protein, serum corrected calcium and blood phosphorus (r=-0.091, 0.202, 0.048, 0.200, P=0.831, 0.373, 0.673, 0.343). Conclusion In hemodialysis patients, the level of serum bicarbonate is related to the level of T3.