未成年肾病综合征患者血清甲状腺激素表达谱变化研究

胡金喜 朱小丽

[摘要] 目的 分析未成年肾病综合征（NS）患者血清甲状腺功能表达谱的变化情况。 方法 收集2012年7月～2019年7月在我院就诊的小于18周岁NS患者55例临床及实验室信息，其中首次发病患者28例，复发患者27例，以59例健康体检未成年人作为健康对照组。分析NS患者及健康对照者甲状腺功能表达谱的差异，用相关性分析分析甲状腺功能表达与各个指标的相关性。 结果 首次发病NS患者血清FT3、TT3、TT4、rT3、TGAb、TPO水平显著低于健康对照组，血清TSH水平显著高于健康對照组，差异均有统计学意义（P<0.05）;复发NS患者血清FT3、TT3、TT4、TGAb、TPO水平显著低于健康对照组，血清TSH水平显著高于健康对照组，差异均有统计学意义（P<0.05）。首次发病NS患者与复发NS患者各指标之间均无差异（均P>0.05）。首次发病NS患者中TT3与ALB（r=0.744，P<0.001）、PA（r=0.658，P<0.001）呈强正相关，TT3与Scr（r=-0.678，P<0.001）呈强负相关。TT4与ALB（r=0.604，P<0.001）、PA（r=0.646，P<0.001）呈强正相关。复发NS患者中，TT3与APOA1（r=0.648，P<0.001）呈强正相关。结论 未成年NS患者存在甲状腺激素水平低下的情况，但首次发病和复发NS患者甲状腺激素水平与血清蛋白及肾功能指标相关性有差异。

[关键词] 未成年人;肾病综合征;甲状腺激素;表达谱

[中图分类号] R726.9          [文献标识码] A          [文章编号] 1673-9701（2020）18-0009-06

A study of the changes in serum thyroid hormone expression spectrum in juvenile patients with nephrotic syndrome

HU Jinxi1   ZHU Xiaoli2

1.Department of Tumor Surgery， Taizhou Hospital of Zhejiang Province， Taizhou   317000， China; 2.Department of Clinical Laboratory， Taizhou Hospital of Zhejiang Province， Taizhou   317000， China

[Abstract] Objective To investigate the changes in serum thyroid hormone expression spectrum in juvenile patients with nephrotic syndrome（NS）. Methods The clinical and laboratory information of fifty-five NS patients younger than 18 years old admitted to our hospital from July 2012 to July 2019 were collected， including twenty-eight patients with first onset and twenty-seven patients with relapse. Fifty-nine healthy juveniles were taken as the healthy control group， and correlation analysis was used to analyze the correlation between a thyroid function expression and various indexes. Results The levels of serum FT3， TT3， TT4， rT3， TGAb and TPO in patients with first onset NS were significantly lower than those in healthy control group， and the levels of serum TSH were significantly higher than those in healthy control group， with statistical significance（P<0.05）. The levels of serum FT3， TT3， TT4， TGAb and TPO in patients with relapsed NS were significantly lower than those in healthy control group， and the levels of serum TSH were significantly higher than those in healthy control group， with statistical significance（P<0.05）. There was no difference between patients with first onset NS and relapsed NS（all P>0.05）. TT3 was strongly positively correlated with ALB（r=0.744， P<0.001）， PA（r=0.658， P<0.001） and TT3 was strongly negatively correlated with Scr（r=-0.678， P<0.001） in patients with first onset NS. TT4 was strongly positively correlated with ALB（r=0.604， P<0.001） and PA（r=0.646， P<0.001）. In patients with relapsed NS， TT3 was strongly positively correlated with APOA1（r=0.648， P<0.001）. Conclusion Low thyroid hormone levels exist in juvenile patients with NS， but the correlation between thyroid hormone levels and serum protein and renal function indexes is different between patients with first onset and relapse NS.

[Key words] Juveniles; Nephrotic syndrome; Thyroid hormone; Expression spectrum

肾脏和甲状腺激素之间的相互作用是维持肾脏和甲状腺这两个重要器官正常功能的重要因素，一方面，甲状腺激素在肾脏结构的早期发育中起着重要的作用，且在调节肾小球和肾小管功能以及水和电解质的平衡中起着重要的作用，另一方面，肾脏在甲状腺激素的新陈代谢和消除中起重要作用[1]。因此，任何一个器官功能上的缺陷均将对这两个系统产生影响。肾病综合征（Nephrotic syndrome，NS）是儿童常见的肾脏疾病[2]，尿蛋白排泄过多是其主要的特征之一[3]。蛋白尿的原因是肾小球毛细血管壁通透性增加及近端小管上皮细胞的再吸收受损。虽然NS引起的蛋白尿为选择性，白蛋白构成了蛋白质排泄的主要部分，但许多其他重要的球蛋白、激素和激素结合蛋白也大量排泄，影响甲状腺功能。……