The Clinical Study Of The Relationship Between Thyroid Function And The Root Sydromes In Continuous Ambulatory Peritoneal Dialysis Patients

BackgroundChronic kidney disease (CKD) is a common chronic disease. In recent years, several studies have shown that in patients with end-stage renal disease with a series of thyroid hormone levels and metabolic abnormalities. There are just a few domestic studies on thyroid function in continuous ambulatory peritoneal dialysis (CAPD) patients, particularly the lack of investigation and analysis on the relationship between thyroid function and TCM Syndrome type in CAPD patients.Objectives1,To access CAPD patients with thyroid function of the distribution and related factors;2,To explore the relationship and mechanisams between low thyroid hormone status and adverse clinical outcome in CAPD patients;3,To explore the correlation between status of thyroid function and the Root syndrome type in CAPD patients,to provide a theoretical basis for treatment of thyroid dysfunction in traditional Chinese medicine and improvement of clinical symptoms and quality of life.MethodsA cross-sectional study was performed in CAPD patients treated in the division of nephrology, Peking University Third Hospital in March and April 2009. Design information collection form for CAPD patients, through access to Peking University Third Hospital dialysis center and the original medical records electronic medical records system to collect data include patient demographic data, TCM syndromes, blood biochemistry and thyroid hormone series, nutritional status, inflammation, atherosclerosis and dialysis adequacy; collect information of complications and death records by looking for the original diagnosis and follow-up of dialysis patients. Cox regression model was established to explore the correlation between low thyroid hormone status and poor clinical prognosis. Comparisons between groups and multivariate analysis were used to explore the relationship between Gan-Shen Yin-deficiency type and free serum triiodothyronine.Result1,131 patients (male 54.2%) were included in the present study, the average value of FT3 was (2.51±0.39) pg/ml, including 80cases with normal thyroid function,38 cases with low T3 syndrome,10 cases with subclinical hypothyroidism,2 cases with subclinical hyperthyroidism, and lcase with hypothyroidism. Correlation analysis showed that the serum FT3 was significantly correlated with age, dialysis adequacy, malnutrition (SGA, serum albumin), inflammation (CRP), atherosclerosis (PWV), but not significant correlation with sex, primary disease and blood lipids.2,Based on the distribution of thyroid function of 94 CAPD patients with thyroid stimulating hormone (TSH)<20uIU/mL, cases divided into three groups, normal thyroid function group (63 cases), low T3 syndrome group (24 cases) and subclinical hypothyroidism (7 cases).The average age of low T3 syndrome group was largest, serum albumin lower than the normal thyroid function group, and PWV was significantly higher, all of them were statistically significant, P<0.05; SGA value, 1gCRP of the subclinical hypothyroidism group were significantly different compare with the normal thyroid function group, P<0.05.Pearson and Spearman correlation analysis showed that, FT3 significantly correlated to age, dialysis adequacy, SGA, albumin and lgCRP, P<0.01; FT3 was negatively correlated with PWV (r=-0.199, P=0.054), close to the statistical significance. ANOVA results are shown FT3 value of the MIA syndrome group was significantly lower than other non-MIA syndrome groups, P<0.01. Cox regression model showed that, higher aged persons, a higher risk of complications occurred (β=0.952, P=0.018), after adjusting for gender, diabetes, age and dialysis adequacy of dialysis and other factors, while there is low thyroid function (low T3 or subclinical hypothyroidism), malnutrition, inflammation, atherosclerosis more than any of the three factors, the occurrence of the risk of complications was significantly higher (β3=14.803, P3=0.004;β4=32.702, P4=0.002)3,89 patients with normal thyrotropin were included in the present study. Patients were divided into two groups, Gan-Shen Yin-deficiency type(n=19) and non-Gan-Shen Yin-deficiency type(n=70). TT3, TT4 and FT3 were significantly lower in patients of Gan-Shen Yin-deficiency type than those of non-Gan-Shen Yin-deficiency type(TT3,0.96±0.23ug/mL vs 1.13±0.22ug/mL,P=0.006; TT4, 7.59±1.69ug/mL vs 8.65±1.55ug/mL, P=0.017; FT3,2.35±0.35 pg/mL vs 2.57±0.33 pg/mL, P=0.014). Multivariate analysis further showed that Gan-Shen Yin-deficiency, serum albumin, C-reaction protein and residual renal Kt/V were independent risk factors affecting the level of FT3 after adjusting for age, sex, dialysis vintage and diabetic status(R2=0.396, P=0.000).Conclusion1,This study found that CAPD patients with low thyroid hormone levels to decline in the main serum FT3 concentration;2,Low thyroid hormone status is strongly correlated to malnutrition inflammation-atherosclerosis syndrome in CAPD patients;3,With any three of the factors, low thyroid hormone status (low T3 syndrome or subclinical hypothyroidism), malnutrition, inflammation, atherosclerosis, the risk of complications of CAPD patients was significantly higher, particularly with four of them.4,This study shows that different types of the root syndrome of CAPD patients whose thyroid function is also different. Furthermore, Gan-Shen Yin-deficiency type is an independent risk factor of the reduction of FT3 in CAPD patients.