本文關鍵詞： 原發(fā)性腎病綜合征 甲狀腺激素 甲狀腺病態(tài)綜合征 尿蛋白　出處：《皖南醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過分析原發(fā)性腎病綜合征患者血清甲狀腺激素水平變化與病理類型的關系,深入了解原發(fā)性腎病綜合征與甲狀腺激素水平之間的關系,進一步指導臨床原發(fā)性腎病綜合征的治療。方法:收集2015年2月至2016年12月期間在我科(皖南醫(yī)學院弋磯山醫(yī)院腎內科)住院,確診為原發(fā)性腎病綜合征的且既往無甲狀腺相關病史及繼發(fā)性腎病綜合征的75例患者的資料,該75例患者設為觀察組(PNS組),其中甲狀腺功能正常35例(A組),甲狀腺功能異常40例(B組),并選擇同期在我院健康體檢的75例人員作為對照組(C組)。比較對照組(C組)與PNS組(A組、B組)甲狀腺激素水平,并分析原發(fā)性腎病綜合征(PNS組)患者血清白蛋白(ALB),血脂(TC,TG),血肌酐(Scr),尿素氮(Urea),24小時尿蛋白定量等相應生化指標與甲狀腺功能的相關性以及甲狀腺激素水平與其病理類型的相關性。結果:在75例原發(fā)性腎病綜合征(PNS)患者中,甲狀腺功能異常有40例,占53.3%(40/75),生化檢查多以游離三碘甲狀腺(FT3),游離甲狀腺素(FT4)下降為主,可伴有促甲狀腺素(TSH)升高。PNS組與對照組(C組)比較,FT3及FT4下降明顯,血清TSH升高較對照組明顯,差異均有顯著統(tǒng)計學意義(P0.01)。PNS組與對照組(C組)相比,PNS組中男性患者54例,女性患者21例,分別占72%,28%;患者年齡平均(43.65±11.779)周歲;對照組中男性51名,女性24名,分別占68%,32%;年齡平均值(40.00±11.209)周歲,兩組性別、年齡數(shù)據(jù)經(jīng)檢驗均無統(tǒng)計學意義(P0.05),表明性別及年齡與疾病程度無關。對照組(C組)ALB較觀察組(PNS組)高,其TC、TG、Scr、Urea低于觀察組,且差異均具有統(tǒng)計學意義(P0.05)。PNS組內比較,甲狀腺功能異常組(B組)FT3及FT4水平、血清白蛋白(ALB)低于甲狀腺功能正常組(A組),而Scr、Urea、24小時尿蛋白定量高于甲狀腺功能正常組(A組),其差異均有統(tǒng)計學意義(P0.05);此外,B組FT3、FT4與Scr、Urea成負相關性,FT3、FT4與血清白蛋白(ALB)呈正相關性,B組中不同程度24h尿蛋白定量與其對應FT3、FT4呈負相關性;其FT3、FT4、TSH與TG、TC無明顯相關關系(P均0.05)。A組與B組不同腎臟病例類型構成比之間無顯著差異(P=0.991),尚無法證明甲狀腺功能異常與病理類型有相關關系。結論:1.PNS患者易伴有甲狀腺功能異常,通常以正常甲狀腺病態(tài)綜合征為主,生化檢查示:FT3及FT4降低,同時伴TSH升高。其甲狀腺水平降低程度,尤其是血清FT3降低水平往往與病情嚴重成正相關。2.甲狀腺激素水平,尤其FT3、FT4與尿蛋白呈負相關,與血清白蛋白成正相關,因此治療PNS合并甲狀腺功能異常的關鍵在于減少尿蛋白流出。3.積極治療原發(fā)性腎病綜合征,定期復查甲狀腺功能,對于疾病預后有很大幫助。4.PNS患者行腎活檢后可表現(xiàn)微小病變性腎病,系膜增生性腎病,膜性腎病等多種,尚無明確證據(jù)證明PNS患者甲狀腺功能異常與其相應的病理類型有相關性。
[Abstract]:Objective: to study the relationship between serum thyroid hormone level and pathological type in patients with primary nephrotic syndrome (PNS). Methods: from February 2015 to December 2016, we were hospitalized in our department (Department of Renal Medicine, Yiji Shan Hospital, Southern Anhui Medical College). Data of 75 patients with primary nephrotic syndrome who had no history of thyroid associated diseases and secondary nephrotic syndrome. The 75 patients were divided into the observation group (PNS group), 35 cases of normal thyroid function in group A and 40 cases of abnormal thyroid function in group B, and 75 cases of healthy check-up in our hospital were selected as the control group C in the same period. The thyroid hormone levels in group A and group B were compared with those in group PNS. The correlation between serum albumin and thyroid function, serum albumin, serum lipid, serum creatinine, creatinine, urinary protein and thyroid function in patients with primary nephrotic syndrome (PNS group) were analyzed. The relationship between serum albumin and thyroid function, thyroid hormone level and pathological changes were also analyzed in patients with primary nephrotic syndrome (PNS group), such as serum albumin, serum lipids, serum creatinine, creatinine creatinine and urinary protein in 24 hours. Results: in 75 patients with primary nephrotic syndrome (PNS), There were 40 cases of thyroid dysfunction, accounting for 53.3% of 40 / 75%. The main biochemical examination was free triiodothyronine FT3, free thyroxine FT4, which could be accompanied by the increase of thyrotropin TSH. The decrease of FT3 and FT4 in the PNS group was significantly higher than that in the control group (C group). The increase of serum TSH was significantly higher than that of the control group (P 0.01g. PNS group and control group C). There were 54 male patients and 21 female patients in the control group, accounting for 72% of the total, the average age of the patients was 43.65 鹵11.779 years old, 51 male patients in the control group, and 51 male patients in the control group, the average age of the patients was 43.65 鹵11.779 years old, and the mean age of the patients was 43.65 鹵11.779 years. The mean age was 40.00 鹵11.209 years old. There was no significant difference in sex and age data between the two groups (P 0.05), which indicated that the sex and age were not related to the degree of disease. The ALB in control group C was higher than that in observation group (P NS), and its TCGGScrUUU was lower than that in observation group. There were significant differences in FT3 and FT4 levels in group B with abnormal thyroid function. Serum albumin (ALB4) was lower than that of normal thyroid function group (group A), while 24 hour urinary protein quantity of Scrr UreaI group was higher than that of normal thyroid function group (P 0.05). In addition, there was a negative correlation between FT3F3 FT4 and ScrUrea in group B and serum white egg. There was a positive correlation between ALB and FT3 FT4 in B group. There was no significant correlation between TSH and TGTC in FT3 / FT4 / TSH group. There was no significant difference between group A and group B (P < 0.05). There was no significant difference in the ratio of different renal types between group A and group B. there was no significant correlation between thyroid dysfunction and pathological type. Conclusion: 1.The patients with PNS are prone to be accompanied with abnormal thyroid function. Normal thyroid sick syndrome is usually the main disease. Biochemical examination showed that the ratio of FT3 and FT4 decreased and TSH increased. The decrease of thyroid gland level, especially the decrease of serum FT3 level, was positively correlated with the severity of the disease. The thyroid hormone level was found to be positively correlated with the level of thyroid hormone, and the serum FT3 level was positively correlated with the severity of the disease. In particular, FT3 FT4 is negatively correlated with urinary protein and positively correlated with serum albumin. Therefore, the key to treat PNS with thyroid dysfunction is to reduce urinary protein outflow. It is very helpful for the prognosis of the disease. 4. PNS patients can show minimal change nephropathy, Mesangial proliferative nephropathy, membranous nephropathy and so on after renal biopsy. There is no clear evidence that thyroid dysfunction in PNS patients is associated with their corresponding pathological types.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692

【參考文獻】

相關期刊論文 前10條

1 秦麗珍;;腎病綜合征合并低鈉血癥的臨床診治分析[J];中國醫(yī)藥指南;2016年21期

2 袁小強;;原發(fā)性腎病綜合征并發(fā)急性腎功能衰竭臨床診治與分析[J];中國實用醫(yī)藥;2015年09期

3 姜傳學;;原發(fā)性腎病綜合征54例臨床診治觀察[J];現(xiàn)代診斷與治療;2014年23期

4 張書鋒;李玉柳;劉翠華;;腎病綜合征合并低鈉血癥的臨床診治分析[J];中國實用醫(yī)藥;2014年30期

5 湯英俊;;小兒腎病綜合征臨床診治探討[J];現(xiàn)代養(yǎng)生;2014年20期

6 黃琴;何慶南;;小兒激素耐藥型腎病綜合征的發(fā)病機制及臨床診治研究進展[J];湖北科技學院學報(醫(yī)學版);2014年05期

7 白楊;沈凱;;腎病綜合征時血栓形成的病理生理機制及臨床診治[J];檢驗醫(yī)學與臨床;2014年16期

8 莊乙君;胡學芹;林葉;;老年原發(fā)性腎病綜合征患者上呼吸道感染的臨床分析[J];中華醫(yī)院感染學雜志;2014年15期

9 周姍姍;李劍文;林志鑫;傅君舟;;286例腎病綜合征患者臨床與病理分析[J];廣州醫(yī)藥;2014年04期

10 郝英雙;李珊珊;宋紅娟;;腎病綜合征患兒醫(yī)院感染相關因素分析[J];中華醫(yī)院感染學雜志;2014年05期

，

本文編號：1551480