本文選題：終末期腎臟病 + 血液透析　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:慢性腎衰竭患者普遍存在甲狀腺功能紊亂,影響下丘腦-垂體-甲狀腺軸及外周循環(huán)中的甲狀腺激素的轉(zhuǎn)化,常表現(xiàn)為低T3(三碘甲狀腺原氨酸)或低T4(總甲狀腺素)綜合征,TSH水平不受影響,而這種甲狀腺功能的紊亂的臨床表現(xiàn)常常被尿毒癥癥狀所掩蓋。此外,維持性血液透析也會對甲狀腺激素的代謝和循環(huán)產(chǎn)生影響。已知非甲狀腺疾病患者的低T3或低T4狀態(tài)會對認(rèn)知功能產(chǎn)生影響,但對于終末期腎病患者的這種甲狀腺功能紊亂,是否會對認(rèn)知功能產(chǎn)生影響,尚缺乏報道。終末期腎病患者的認(rèn)知障礙嚴(yán)重影響著患者的治療進展和生活質(zhì)量,本研究旨在調(diào)查維持性血液透析患者甲狀腺激素水平的變化,并探究其對認(rèn)知功能的影響。方法:選取河北醫(yī)科大學(xué)第三醫(yī)院腎內(nèi)科于2014年10月至2014年12月行MHD的患者39例及住院慢性腎衰竭非透析患者(均為CKD5期患者)35例為研究對象。記錄所有患者性別、年齡、透析齡、原發(fā)病等一般信息及MHD患者的透析前、后血壓和透析過程中血壓變化。采用中文版蒙特利爾量表評估患者的認(rèn)知功能,若入組患者的受教育年限小于12年者則總分加1分,總分26分的患者被認(rèn)為存在認(rèn)知功能損害。同一調(diào)查員依據(jù)蒙特利爾量表標(biāo)準(zhǔn)指導(dǎo)語,對入組患者進行神經(jīng)心理學(xué)量表測試,詳細記錄結(jié)果。所有量表完成時間均為患者接受透析治療前。血樣懫集時間均為患者行血液透析治療前,未透析患者于測試當(dāng)日清晨空腹采血。分析透析組和非透析組認(rèn)知功能和甲狀腺激素水平的差異;并根據(jù)年齡將透析組和非透析組分為老年組和非老年組兩個亞組,分析兩亞組患者認(rèn)知功能和甲狀腺激素水平的關(guān)系。結(jié)果:74例患者年齡為18歲~78歲,平均55.1±15.1歲。其中男性37例(50%),女性37例(50%),原發(fā)病為慢性腎小球腎炎者54例(72.9%)、糖尿病腎病者14例(18.9%)、高血壓腎損害者4例(5.4%)、干燥綜合征者1例(1.3%)、左腎透明細胞癌者1例(1.3%)。MHD患者透析齡為5~154月,平均34.2±31.4個月。74例患者全部完成了量表,平均得分為25.6±2.35,其中28例量表得分26分,認(rèn)知功能損害發(fā)生率為37.83%。T3平均水平1.17±0.32nmol/l,44例存在低T3,發(fā)生率為59.5%。透析組和非透析組患者在T3水平上存在顯著差異(P0.05),但在認(rèn)知水平上無明顯差異(P0.05)。透析組中,老年組和非老年組在認(rèn)知功能和T3水平上存在顯著差異(P0.05);老年組中認(rèn)知損害組與認(rèn)知正常組相比,原發(fā)病為糖尿病腎病、受教育時間,血鈣、血磷水平存在差異(P0.05),但與T3水平無關(guān)(P0.05);非老年組中認(rèn)知損害組與認(rèn)知正常組參與者受教育程度、超濾量存在顯著差異(P0.05),與T3水平無關(guān)(P0.05);透析組患者中T3正常與T3減低的血漿白蛋白水平和年齡構(gòu)成上存在顯著差異(P0.05)。非透析組中,老年組和非老年組在認(rèn)知水平上存在顯著差異(P0.05);老年組認(rèn)知損害組與認(rèn)知正常組相比,在受教育水平上存在顯著差異(P0.05),與T3水平相關(guān)(P0.05);非老年組在受教育水平上存在顯著差異(P0.05),與T3水平無關(guān)(P0.05)。非透析患者中T3正常與T3減低的患者血漿白蛋白水平和血鈣水平上存在顯著差異(P0.05)。結(jié)論:1終末期腎病患者普遍存在T3水平減低,血液透析治療可以顯著升高患者T3水平,但對認(rèn)知功能無顯著影響。2對于透析和非透析患者,T3水平主要與白蛋白水平相關(guān)。3透析患者認(rèn)知水平主要與受教育程度相關(guān),受教育時間越短發(fā)生認(rèn)知損害可能性越大。而非透析組認(rèn)知水平主要與年齡相關(guān),年齡越大認(rèn)知損害發(fā)生可能性越大。4維持性血液透析患者的低T3狀態(tài)沒有造成認(rèn)知功能損害,無需采取甲狀腺激素替代治療。非透析老年患者的血清T3水平與認(rèn)知得分相關(guān),需要注意這些患者的甲狀腺激素變化及認(rèn)知功能的改變。
[Abstract]:Objective: there is a general presence of thyroid dysfunction in patients with chronic renal failure, affecting the transformation of thyroid hormones in the hypothalamus pituitary thyroid axis and peripheral circulation, often characterized by low T3 (three iodine thyroxine) or low T4 (total thyroxine) syndrome, and the level of TSH is not affected, and the clinical manifestations of this thyroid dysfunction often occur. It is covered by the symptoms of uremia. In addition, maintenance hemodialysis can also affect the metabolism and circulation of thyroid hormones. Low T3 or low T4 status in patients with non thyroid diseases is known to affect cognitive function, but whether the thyroid dysfunction in patients with end-stage renal disease may affect cognitive function is still lacking. Lack of reports. Cognitive impairment in patients with end-stage renal disease seriously affects the treatment progress and quality of life. The purpose of this study was to investigate the changes in thyroid hormone levels in maintenance hemodialysis patients and to explore their effects on cognitive function. Methods: the Department of nephrology in the Third Hospital of Hebei Medical University was selected from October 2014 to December 2014. 39 patients with MHD and 35 cases of chronic renal failure in non dialysis patients (all CKD5 patients) were studied. Record all patients' gender, age, age, age, primary disease and other general information as well as the changes of blood pressure and blood pressure in MHD patients before and after dialysis. The Chinese version of the Montreal scale was used to evaluate the cognitive function of the patients, if the patients were enrolled in the group. The total score of the patient was less than 12 years and the total score was 1 points, and the total score of 26 was considered to have cognitive impairment. The same investigator, based on the Montreal scale standard guidance, carried out a neuropsychological scale test for the patients in the group, and recorded the results in detail. Before the patients were treated with hemodialysis, the patients in the non dialysis group were collected on the morning of the morning on the day of the test. The differences in cognitive function and thyroid hormone levels between the dialysis group and the non dialysis group were analyzed, and the age group and the non dialysis group were divided into two subgroups of the elderly group and the non elderly group. The cognitive function and the thyroid function of the two subgroups were analyzed. Results: the relationship between adenoid hormone level. Results: the age of 74 patients was 18 years old ~78 years old, with an average of 55.1 + 15.1 years old. Among them, 37 cases (50%), 37 cases (50%), 54 patients with chronic glomerulonephritis (72.9%), 14 (18.9%) patients with diabetic nephropathy, hypertensive renal damage patients (5.4%), cases of dry syndrome, and left renal cell carcinoma patients. The age of.MHD patients was 5~154 months, and the average score of.74 patients was 25.6 + 2.35 in average 34.2 + 31.4 months. The average score of 28 cases was 26. The incidence of cognitive impairment was 1.17 + 0.32nmol/l, 44 cases had low T3, and the incidence was 59.5%. The dialysis group and non dialysis group were displayed on the T3 level. There was no significant difference (P0.05), but there was no significant difference in cognitive level (P0.05). In the dialysis group, there was a significant difference in the cognitive function and the level of T3 (P0.05) in the elderly group and the non elderly group (P0.05); the cognitive impairment group in the elderly group was compared with the cognitive normal group, the primary disease was diabetic nephropathy, the education time, blood calcium, and blood phosphorus levels were different (P0.05), but with T3 water. There was significant difference in the level of education between the cognitive impairment group and the cognitive normal group in the non elderly group (P0.05) and the level of T3 (P0.05). There were significant differences in the plasma albumin level and age composition between the normal T3 and the T3 decreased (P0.05) in the dialysis group (P0.05). In the non dialysis group, the elderly group and the non elderly group were in the non dialysis group. There were significant differences in cognitive level (P0.05). There were significant differences in the level of Education (P0.05) in the cognitive impairment group of the elderly group (P0.05) and the level of T3 (P0.05); there were significant differences in the level of Education (P0.05) in the non elderly group (P0.05). In non dialysis patients, the plasma of T3 normal and T3 decreased in the non dialysis patients. There was a significant difference in albumin level and blood calcium level (P0.05). Conclusion: 1 end-stage renal disease patients generally have decreased T3 level, and hemodialysis therapy can significantly increase the level of T3 in patients, but there is no significant effect on cognitive function in.2 for dialysis and non dialysis patients, and the level of T3 is mainly related to the level of cognitive level in patients with albumin level associated with.3 dialysis. The higher the educational level is, the shorter the cognitive impairment is, the greater the likelihood of cognitive impairment. The greater the age, the older the cognitive impairment is, the greater the age of the cognitive impairment, the lower the T3 status of.4 maintenance hemodialysis patients does not cause cognitive impairment and no need for thyroid hormone replacement therapy. Analysis of serum T3 level in elderly patients is related to cognitive score. Thyroid hormone changes and cognitive function in these patients need to be noted.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.5

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