Relative Factors Of Hypothyroid Hypothyroidism In Patients With Chronic Kidney Disease

Objective:Chronic kidney disease（CKD）has become a major disease that threatens human health.Current research shows that the incidence of subclinical hypothyroidism（SCH）is significantly higher in the CKD population than in the general population.There is a significant correlation between SCH and CKD.The purpose of this study is to further study the relevant factors of SCH in patients with CKD,and to provide some reference for future clinical diagnosis and treatment.Methods:We collected and selected 111 cases of CKD hospitalized in the Department of Nephrology at Linyi Central Hospital from February 2016 to October 2017 as the study object.63 cases without CKD in the physical examination center were the control group.Clinical data and serum were collected from both groups.Biochemical indicators and detection of thyroid function,including free triiodothyronine FT₃,free thyroxine FT₄,thyroid-stimulating hormone TSH,estimated glomerular filtration rate eGFR);single factor pairwise comparison and multivariate logistic regression analysis were performed on SCH-related factors.Results:Among 111 patients with CKD,49（44.1%）were female and 62（55.9%）were male.The mean age was 52.68±14.31 years.The mean systolic blood pressure was138.55±22.28 mmHg,and the serum creatinine was 134.20±121.80μmol/L.eGFR 69.65±36.20 ml/min/1.73m²,63 control subjects,32 women（42.1%）,average age 55.03±13.49years,mean systolic blood pressure 132.17±18.06mmHg,serum creatinine87.08±82.10μmol/L,eGFR 84.30±23.30 ml/min/1.73m².In CKD patients,25 cases of SCH patients were detected,the prevalence rate was 22.5%,and 8 cases were detected in the control group.The prevalence was 10.5%,and the difference was statistically significant（P<0.05）.Among the CKD patients,61 patients with hypertension were detected,the prevalence rate was 55.0%,and 30 patients in the control group were detected,the prevalence rate was 39.5%.The difference was statistically significant（P<0.05）.Diabetes was detected in CKD patients.In 20 patients,the prevalence rate was18.0%.In the control group,15 patients were detected.The prevalence rate was 19.7%.The difference was not statistically significant（P>0.05）.Twenty-two patients with cardiovascular disease were detected in CKD patients.The rate was 19.8%,11 cases were detected in the control group,the prevalence rate was 17.1%,and the difference was not statistically significant（P>0.05）.Our study showed that the prevalence of hypertension in CKD patients was higher,the level of systolic blood pressure,serum creatinine,24 hourly proteinuria,blood uric acid,erythrocyte sedimentation rate,total cholesterol were higher,serum albumin,low density lipoprotein and eGFR were lower,and the difference was statistically significant（P<0.05）.Compared with the control group,there was no significant difference in age,sex,diabetes and prevalence of cardiovascular diseases between the two groups.Compared with the non SCH group,the systolic pressure,blood sugar and 24 hour urine protein were higher in the SCH group,and the eGFR and serum albumin index were lower in CKD patients than those in the non group（P<0.05）.There was no significant difference in age,sex,diabetes,hypertension and coronary heart disease between the two groups（P>0.05）.The multiple factor logistics regression analysis using the stepwise elimination method showed that the final regression model introduced the variable in the table,and the ratio of the systolic pressure（Odds ratio,OR value）was 1.035（1.006¹.065）after correcting the age,sex and uric acid,total cholesterol,high density lipoprotein,fasting blood glucose,urea nitrogen and so on.)（P<0.05）,the OR value of eGFR is 0.951（0.921 to 0.983）,（P<0.01）,the OR value of the24 hour urine protein is 1.135（1.017 to 1.268）,and（P<0.05）,and the factor of SCH is still the relative factor of SCH,and the systolic pressure increases every 1mmHg,and the risk increases every ml/min/1.73m².The risk of urine protein increased by 13.5%per 1g.Conclusion:The prevalence of SCH in patients with CKD was higher than that in the general population;eGFR,systolic blood pressure,and 24-hour urinary protein quantitation were independent factors for the occurrence of SCH in CKD patients.