本文選題：原發(fā)性腎病綜合征　切入點：甲狀腺激素　出處：《福建醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的探討原發(fā)性腎病綜合征患者甲狀腺功能變化與其尿蛋白水平及病理關系。 方法回顧性分析廈門大學附屬中山醫(yī)院腎內(nèi)科收治的82例原發(fā)性腎病綜合征（Primary Nephrotic Syndrome，PNS）患者（PNS組），排除既往有甲狀腺相關疾病史患者，根據(jù)甲狀腺激素水平分為甲狀腺功能正常組（NG組）、甲狀腺功能異常組（AG組），選20例我院正常體檢者為對照組(CG組)，比較PNS組與CG組間的甲狀腺激素水平；比較NG組與AG組患者血清白蛋白、血脂、肌酐、尿素氮、尿微量白蛋白等水平及與甲狀腺功能的相關性，觀察各腎臟病理類型與甲狀腺功能的關系。 結果①82例PNS患者中甲狀腺功能正常20例，甲狀腺功能異常62例，其中甲狀腺功能減退癥10例，，甲狀腺功能亢進癥2例，非甲狀腺性的病態(tài)綜合征49例，橋本甲狀腺炎1例。PNS組與CG組比較，F(xiàn)T3、FT4顯著降低（FT3：3.22±1.55pmol/l VS4.44±0.93pmol/l，F(xiàn)T4：13.08±3.51pmol/l VS19.20±2.77pmol/l），TSH顯著升高（4.09±4.11uIU/l VS2.48±1.06uIU/l），差異均有統(tǒng)計學意義（均p＜0.05）。②AG組與NG組比較，血清白蛋白更低（18.28±5.31g/l VS22.87±3.61g/l，p＜0.05)，而尿微白蛋白更高（8873.52±6990.76mg/l VS3167.8±1629.66mg/l，p＜0.05）。③AG組FT3、FT4與血清白蛋白呈正相關（FT3：r=0.301，p＜0.05；FT4：r=0.311，p＜0.05）；FT4與尿微白蛋白呈負相關(r=-0.282，p＜0.05)， FT3與尿微量白蛋白相關性不明顯（r=-0.177，p＞0.05）；而THS與血清白蛋白呈負相關、與尿微量白蛋白呈正相關（均p＜0.05），TH與血脂則無相關性(均p＞0.05)。④NG組與AG組不同腎臟病理類型構成比無明顯差異（χ2=2.223, p=0.695＞0.05）。 結論①PNS患者臨床上易合并甲狀腺功能異常，主要表現(xiàn)為非甲狀腺疾病綜合征，檢測甲狀腺功能可以協(xié)助評估病情。②PNS患者出現(xiàn)甲狀腺功能異常既可能是病態(tài)情況下機體的一種保護性機制，還可能與攝取原料減少、低蛋白血癥、藥物作用、免疫損傷的因素有關。③FT3、FT4與血清白蛋白呈正相關，與尿微量白蛋白呈負相關，尚不能認為PNS患者出現(xiàn)甲狀腺功能異常與腎臟病理類型有關。
[Abstract]:Objective to investigate the relationship between thyroid function and urinary protein level in patients with primary nephrotic syndrome. Methods A retrospective analysis of 82 patients with primary Nephrotic Syndrome PNS was performed in the Department of Renal Medicine, Zhongshan Hospital affiliated to Xiamen University, and the history of thyroid related diseases was excluded. According to the thyroid hormone level, the thyroid hormones were divided into two groups: normal thyroid function group (NG group) and abnormal thyroid function group (AG group). Twenty healthy persons in our hospital were selected as control group (CG group). The thyroid hormone levels between PNS group and CG group were compared. The relationship between serum albumin, serum lipid, creatinine, urea nitrogen, urinary microalbumin and thyroid function was compared between NG group and AG group. Results there were 20 cases of normal thyroid function and 62 cases of abnormal thyroid function, including 10 cases of hypothyroidism, 2 cases of hyperthyroidism and 49 cases of non-thyroid morbid syndrome. One case with Hashimoto's thyroiditis. Compared with CG group, FT3T4 significantly decreased FT3: 3.22 鹵1.55pmol / L VS4.44 鹵0.93pmol / L VS4.44 鹵0.93pmol / L FT4: 13.08 鹵3.51pmol / L VS19.20 鹵2.77pmol / L TSH significantly increased 4.09 鹵4.11uIUmol / L VS2.48 鹵1.06uIUP / L respectively (P < 0.05.2AG vs NG). Serum albumin was lower (18.28 鹵5.31 g / l VS22.87 鹵3.61 g / L P < 0.05), while urinary microalbumin was higher than 8873.52 鹵6990.76 mg / L VS3167.8 鹵1629.66 mg / L P < 0.05 g / L P < 0.05 mg / L P < 0.05 mg / L 路3AG group (P < 0.05). The correlation between THS and serum albumin was positively correlated with FT _ 3rU _ (0.301) VS22.87 < 0.311p < 0.05 渭 r = 0.311p < 0.05 渭 g / ml. FT3 had no significant negative correlation with urinary microalbumin (r-0.177p > 0.05g / g / g / g / g / g / g / g / g / g / g / 3AG group), but there was a negative correlation between THS and serum albumin (r = -0.177p > 0.05g / g / g / g / g / g / g / g / 3AG / g / g / g / g / g / g / g / g / 3AG group), while a negative correlation between THS and serum albumin was observed. There was no significant correlation between TH and serum lipids (P > 0.05). There was no significant difference in the ratio of different renal pathological types between AG group and AG group (蠂 ~ 2 = 2.223, p ~ 0.695 > 0.05). Conclusion (1) the patients with PNS are easily complicated with abnormal thyroid function, which is mainly characterized by non-thyroid disease syndrome. Detection of thyroid function may assist in assessing thyroid dysfunction in patients with PNS, which may be a protective mechanism of the body under pathological conditions, and may be associated with reduced intake of raw materials, hypoproteinemia, and drug effects. The factors related to immune injury were positively correlated with serum albumin and negatively correlated with urinary microalbumin. The abnormal thyroid function in patients with PNS was not related to the pathological type of kidney.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692


本文編號：1558465