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Cov thyroid hormone hloov kho rau thawj hypothyroidism ua rau kev txhim kho lub raum ua haujlwm tseem ceeb hauv cov neeg mob raum mob.

AbstractKeeb kwm Kev sib cuam tshuam ntawm lub raum thiab cov thyroid ua haujlwm tau paub ntau xyoo; Txawm li cas los xij, muaj qee qhov kev tshawb fawb txog qhov kev txhim kho thiab kev hloov mus sij hawm ntev ntawmlub raum ua haujlwmtom qabthyroid hormone hloovKev kho mob (THRT) hauvmob ntevraumkab mob(CKD) cov neeg mob. Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim seb THRT cuam tshuam li cas rau qhov kwv yees glomerular filtration rate (eGFR) hauv CKD(cmob raum mob)cov neeg mob uas muaj thawj hypothyroidism. Cov txheej txheem Kev tshawb xyuas rov qab tau ua rau 51 tus neeg mob Nyij Pooj (15 tus txiv neej thiab 36 tus poj niam) uas muaj cov thyroid hypothyroidism. Cov kev hloov pauv hauv eGFR tom qab THRT tau tshuaj xyuas raws li qhov muaj nyob ntawm CKD thiab qhov hnyav ntawm cov thyroid ua haujlwm.

Cov txiaj ntsig eGFR nce nrawm dua thawj 6 lub hlis tom qab THRT hauv CKD(cmob raum mob)cov neeg mob, uas tau ua raws li lub toj siab. Muaj kev sib raug zoo ntawm eGFR thiab qhov hnyav ntawm hypothyroidism, uas tsis muaj hnub nyoog, thiab eGFR hauv cov neeg mob hypothyroid hnyav tau nce mus rau qib uas zoo ib yam li cov neeg mob hypothyroid me tom qab THRT. eGFR tau txhim kho ntau dua hauv pawg eGFR qis dua thiab nce txog 30 feem pua ​​​​hauv CKD(cmob raum mob)cov neeg mob (47.5 ± 7.7 vs. 62.1 ± 9.5 ml / min / 1.73 m2, P\0.01). Ntxiv mus, eGFR hauv CKD(cmob raum mob)Cov neeg mob uas muaj me me mus rau nruab nrab hypothyroidism tau nce ntau dua piv rau cov neeg mob uas tsis yog CKD.

XausPeb cov ntaub ntawv qhia tias hypothyroidism pab txo qis hauv eGFR, tshwj xeeb tshaj yog hauv CKD(cmob raum mob)cov neeg mob; Yog li ntawd, cov neeg mob nrog CKD(cmob raum mob)yuav tsum tau kuaj xyuas cov thyroid ua haujlwm zoo thiab tsim nyog THRT

yuav tsum pib yog xav tau.

Ntsiab lusCov thyroid hormone. Hypothyroidism.Mob raum mob. Glomerular pom tus nqi

Cistanche- mob raum mob

Taw qhia

Kev sib cuam tshuam ntawm lub raum thiab cov thyroid ua haujlwm tau paub ntau xyoo, thiab cov thyroid ua haujlwm tsis zoo ua rau muaj kev hloov pauv loj hauv lub raum ua haujlwm [1]. Cov neeg mob hypothyroidism, ob qho tib si overt thiab subclinical, yog tus cwj pwm los ntawm qhov txo qis hauv glomerular filtration rate (GFR) thiab lub raum plasma flow, uas ua rau cov ntshav creatinine nce ntxiv [2-4]. Txawm hais tias nws tau raug tshaj tawm tias cov kev hloov pauv no tuaj yeem thim rov qab nrog kev tswj hwm levothyroxine [5], muaj qee qhov kev tshawb fawb txog kev txhim kho thiab kev hloov mus sij hawm ntev.lub raum ua haujlwmtom qabthyroid hormone hloovKev kho mob (THRT) hauv (CKD(cmob raum mob)) cov neeg mob.

Ntawm qhov tod tes, CKD(cmob raum mob)Nws cuam tshuam nrog kev nce siab ntawm thawj hypothyroidism. lwj, et al. tau tshaj tawm tias qhov kev pheej hmoo ntawm hypothyroidism tau nce ntxiv nrog rau qib qis ntawm lub raum ua haujlwm hauv lub teb chaws tus neeg sawv cev ntawm Asmeskas cov neeg laus thiab hais tias kwv yees li 20 feem pua ​​​​ntawm cov neeg mob uas kwv yees GFRs (eGFRs) < 60="" ml="" min="" 1.73="" m2="" muaj="" cov="" chaw="" kuaj="" mob="" lossis="" cov="" ntaub="" ntawv="" pov="" thawj="" ntawm="" hypothyroidism.="" [6].="" lub="" raum="" txhawb="" nqa="" iodine="" tshem="" tawm="" feem="" ntau="" los="" ntawm="" glomerular="" pom.="" cov="" ntshav="" siab="" iodine="" concentration="" tau="" tshaj="" tawm="" hauv="">(cmob raum mob)Cov neeg mob [7], thiab raug iodine siab tuaj yeem pab txhawb kev txhim kho hypothyroidism [8]. Vim tias feem ntau cov neeg Nyij Pooj haus cov tshuaj iodine ntau dhau, nws muaj peev xwm ua tau tias iodine muaj kev cuam tshuam ntau dua rau hypothyroidism hauv cov neeg Nyij Pooj. Yog li kev tshawb nrhiav rov qab tau ua tiav los tshuaj xyuas seb THRT puas cuam tshuam rau eGFR hauv cov neeg mob Nyij Pooj uas muaj cov thyroid hypothyroidism.

Cov ntaub ntawv thiab cov txheej txheem

Kawm cov pej xeem

Tsib caug-ib tus neeg mob (15 tus txiv neej thiab 36 tus poj niam) uas muaj tus mob hypothyroidism thawj zaug uas tau mus xyuas Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Endocrinology ntawm Kyoto City Tsev Kho Mob thaum xyoo 2002-2010 tau txheeb xyuas rov qab. Txhua tus neeg mob tau txais THRT nrog 25-150 ug levothyroxine txhua hnub los kho euthyroidism. Peb tsis suav cov kev kawm uas tau txais thyroidectomies lossis radioiodine therapy, cov neeg uas tau noj tshuaj antithyroid (meth[1]imazole lossis propylthiouracil) rau hyperthyroidism, thiab cov neeg uas twb tau txais THRT lawm. Cov kab mob comorbid tau suav tias yog qhov zoo yog tias cov neeg mob tau txais ib qho ntawm cov kab mob hauv qab no lossis yog tias lawv tau kho rau ib qho ntawm cov hauv qab no: ntshav qab zib mellitus, hemoglobin A1c C6.5 feem pua; dyslipidemia, yoo mov tsawg-density lipoprotein C140 mg/dl, thiab/los yog yoo mov triglyceride C150 mg/dl; ntshav siab nrog systolic ntshav siab C140 mmHg thiab/los yog diastolic ntshav siab C90 mmHg. Cov keeb kwm yav dhau thiab cov yam ntxwv ntawm ob pawg muaj qhia hauv Table 1.

Kev ntsuas ntsuas thiab ntsuas lub raum ua haujlwm

Dawb triiodothyronine (FT3), dawb thyroxine (FT4), thiab thyrotropin (TSH) tau ntsuas los ntawm electrochemiluminescence immunoassays (ARCHITECT Free T3, ARCHITECT Free T4, thiab ARCHITECT TSH, feem; Abbott Japan Co., Ltd., Tokyo, Nyiv). Qhov kev siv ib txwm muaj rau FT3, FT4, thiab TSH hauv peb lub koom haum yog 1.71–3.71 pg/ml, {{10}}.70–1.48 ng/dl, thiab 0.35–4.94μIU / ml, raws. Me hypothyroidism txhais tau tias yog FT4 [0.8 ng/dl thiab TSH \30μIU / ml; moderate hypothyroidism txhais tau tias yog FT{{0}}.5–0.8 ng/dl thiab TSH 30–79μIU / ml; hnyav hypothyroidism txhais tau tias yog FT4 B0.4 ng/dl thiab TSH C80μIU/ml. Cov qib creatinine hauv cov ntshav kuj tau ntsuas nrog txoj hauv kev enzymatic, thiab GFR tau kwv yees raws li Japanese Society of Nephrology CKD.(cmob raum mob)Phau Ntawv Qhia: eGFR (ml/min/1.73 m²) {{0}} (cov ntshav creatinine ntau ntau [mg/dl])-1.094 9 (hnub nyoog [xyoo])-0287 9 (0.739 yog poj niam) [9]. CKD(cmob raum mob)txhais tau tias yog eGFR \ 60 ml / min / 1.73 m². Lub koom haum ntawm CKD(cmob raum mob)tau tshawb nrhiav raws li cov nram qab no eGFR pawg: eGFR C90, 60–89, thiab 30–59 ml / min / 1.73 m².

Cistanche rau kev txhim kholub raum ua haujlwm

Kev txheeb cais

Kev hloov pauv tsis tu ncua yog qhia raws li qhov nruab nrab ± tus qauv sib txawv. Categorical variables raug nthuav tawm raws li tus lej. Cov kev hloov pauv tsis tu ncua ntawm cov pab pawg tau muab piv nrog qhov tsis sib xws t-test, thiab qhov sib txawv ntawm cov categorical tau muab piv nrog chi-squared test. Qhov kev sib tw t-test tau siv los sib piv eGFR ntawm lub hauv paus thiab tom qab kev kho mob. Kev sib raug zoo ntawm cov thyroid ua haujlwm thiab eGFR tau tshawb nrhiav nrog kev txheeb xyuas cov kab rov tav. Kev tshuaj xyuas ntau qhov kev rov qab los kuj tau ua los txhawm rau txheeb xyuas qhov cuam tshuam ntawm cov thyroid ua haujlwm ntawm eGFR tsis muaj hnub nyoog. Rau kev sib piv ntawm cov pab pawg sib txawv, qhov tseem ceeb ntawm cov ntaub ntawv tau txiav txim siab siv ib txoj kev ANOVA, ua raws li kev sib piv ntawm cov pab pawg neeg txhais tau tias raws li Tukey txoj kev. P\0.05 tau suav tias yog qhov tseem ceeb. Txhua qhov kev txheeb xyuas txheeb cais tau ua tiav siv IBM SPSS Statistics program, version 20 (IBM Corp., Armonk, NY, USA).

Cov txiaj ntsig

Tus neeg mob tus yam ntxwv

Table 1 qhia cov yam ntxwv kho mob ntawm cov kev kawm raws li eGFR. Tsis muaj cov neeg mob eGFR<30 ml/min/1.73="" m2="" .="" there="" were="" no="" differences="" between="" the="" non-ckd="" and="" ckd="">(cmob raum mob)pab pawg rau poj niam txiv neej proportions, lub cev hnyav Performance index, comorbid mob, antithyroid antibodies, thiab levothyroxine koob tshuaj. Cov ntsiab lus hauv CKD(cmob raum mob)pab pawg neeg laus dua li cov nyob hauv pawg tsis yog CKD (65.3 ± 14.0 vs. 54.7 ± 18.7 xyoo, P<0.05). serum="" ft3="" and="" ft4="" were="" significantly="" lower="" in="" the="" ckd="" group="" than="" in="" the="" non-ckd="" group="" (ft3:="" 1.79="" ±="" 0.81="" vs.="" 2.28="" ±="" 0.76="" pg/="" ml,=""><0.05; ft4:="" 0.45="" ±="" 0.20="" vs.="" 0.63="" ±="" 0.27="" ng/dl,=""><0.01). serum="" tsh="" was="" significantly="" higher="" in="" the="" ckd="" group="" than="" in="" the="" non-ckd="" group="" (128.9="" ±="" 145.2="" vs.55.2="" ±="" 56.1="" μiu/ml,=""><>

Cov chav kawm ntawm eGFR tom qab THRT hauv CKD(cmob raum mob)cov neeg mob

Txhawm rau kom paub meej txog cov txheej txheem ntuj tsim ntawm eGFR tom qab THRT, kev tshuaj xyuas ntev tau ua. Daim duab 1 qhia txog kev hloov pauv hauv eGFR los ntawm qhov pib mus rau 36 lub hlis tom qab kho. Lub eGFR tau nce sai dua thawj 6 lub hlis nrog qhov txo qis ntawm TSH hauv CKD(cmob raum mob)cov neeg mob, uas tau ua raws li lub toj siab. Yog li, peb piv eGFR ntawm lub hauv paus thiab 6 lub hlis tom qab kev kho mob hauv cov kev kuaj hauv qab no.

Kev sib raug zoo ntawm eGFR thiab thyroid hormone

Kev txheeb xyuas kab rov tav tau ua los tshawb nrhiav kev sib raug zoo ntawm eGFR thiab cov thyroid ua haujlwm. Muaj kev sib raug zoo ntawm eGFR thiab FT4 (eGFR=26.120 9 FT4 ? 54.455, r=0.350, P<0.01, fig.="" 2a).="" a="" negative="" relationship="" was="" found="" between="" egfr="" and="" serum="" tsh="" (egfr="-13.975" 9="" log="" tsh="" 92.691,="" r="0.337," p\0.05,="" fig.="" 2b).="" when="" the="" analysis="" was="" performed="" using="" multiple="" regressions,="" egfr="" was="" found="" to="" be="" positively="" related="" to="" serum="" ft4="" and="" log="" tsh,="" respectively;="" this="" was="" independent="" of="" age="" (ft4:="" b="0.344," p="0.006," log="" tsh:="" b="-0.410," p="0.001," table="" 2).="" figure="" 2c,="" d="" shows="" the="" difference="" in="" egfr="" according="" to="" thyroid="" function="" at="" baseline="" and="" 6="" months="" after="" treatment.="" egfr="" significantly="" increased="" after="" thrt="" in="" patients="" with="" moderate="" and="" severe="" hypothyroidism.="" moreover,="" the="" decreased="" egfr="" at="" baseline="" in="" these="" patients="" increased="" up="" to="" the="" level="" of="" patients="" with="" mild="">

Fig. 2 Linear regression analyzes between eGFR and free thyroxine (FT4) and b TSH at baseline. Cov nyhuv ntawmthyroid hormone hloovKev kho (THRT) ntawm eGFR raws li cov thyroid muaj nuj nqi (c FT4; d TSH) ntawm lub hauv paus (qhib bar) thiab 6 lub hlis tom qab kev kho mob (puv bar). Tus nqi yog qhov nruab nrab ± SD. r=correlation coefficient. **P \0.01 piv rau eGFR ntawm lub hauv paus

Kev cuam tshuam ntawm THRT ntawm eGFR

Daim duab 3 qhia qhov txawv ntawm eGFR tom qab kev kho mob raws li thawj eGFR qhov tseem ceeb. Cov pab pawg uas qis dua qhov pib eGFR muaj kev txhim kho ntau dua (Ntau dua lossis sib npaug rau 90 ml/min/ 1.73 m2 pawg: 98.0 ± 5.0 vs. 1{{ 52}}0.9 ± 10.1 ml / min / 1.73 m2, P=0.24; 60–89 ml / min / 1.73 m2 pawg: 74.2 ± 9.5 vs. 80.9 ± 12.7 ml / min / 1.73 m2, P\ 0.05; thiab 30–59 ml / min / 1.73 m2 pawg: 47.5 ± 7.7 vs. 62.1 ± 9.5 ml / min / 1.73 m2, P\ 0.01). Thaum kawg, daim duab 4 qhia txog kev hloov pauv hauv FT4, TSH, thiab eGFR tom qab THRT raws li CKD(cmob raum mob)los yog tsis yog-CKD thiab hnyav hypothyroidism los yog me me mus rau nruab nrab hypothyroidism. Muaj kev sib raug zoo[1] nkoj ntawm kev hloov pauv hauv eGFR thiab FT4 (DeGFR=18.574 9 DFT4 - 1.919, r=0.528, P\{{9 }}.01, Fig. 4a) and in eGFR and TSH (DeGFR=8.558 9 log DTSH - 3.963, r=0.437, P<0.01, fig.="" 4b).="" the="" changes="" in="" ft4="" and="" tsh="" in="" the="" patients="" with="" severe="" hypothyroidism="" were="" significantly="" greater="" than="" in="" the="" patients="" with="" mild="" to="" moderate="" hypothyroidism;="" however,="" there="" was="" no="" significant="" change="" between="" ckd="">(cmob raum mob)thiab pab pawg uas tsis yog CKD (Fig. 4c, d). eGFR hauv qhov tsis-CKD(cmob raum mob)pab pawg uas muaj hypothyroidism hnyav tau nce ntau dua piv rau cov pab pawg uas muaj me me mus rau nruab nrab hypothyroidism, thiab cov kev hloov ntawm eGFR hauv CKD(cmob raum mob)pab pawg tau pom muaj qhov zoo sib xws, tab sis tsis muaj qhov tseem ceeb (Fig. 4e, f). Tsis tas li ntawd, eGFR hauv CKD(cmob raum mob)pab pawg uas muaj me me mus rau nruab nrab hypothyroidism tau nce ntau dua piv rau cov uas tsis yog-CKD( cmob raum mob)group (FT4>0.4 ng/dl: DeGFR, 11.3 ± 6.1 vs. 2.8 ± 10.8 ml / min / 1.73 m2, P<0.05;><80 μiu/ml:="" degfr,="" 11.7="" ±="" 5.6="" vs.="" 3.3="" ±="" 14.2="" ml/min/1.73="" m2,=""><>

Daim duab 4 Linear regression tsom xam ntawm kev hloov hauv eGFR thiab FT4 thiab b TSH tom qab THRT (a△eGFR=18 574 9△FT{{0}}.919, r=0.528, P < 0.01;="">△eGFR=8 558 9 log△TSH - 3.963, r=0.437, P< 0.01).="" changes="" in="" ft4="" (c),="" tsh="" (d),="" and="" egfr="" (e,="" f)="" after="" thrt="" according="" to="" the="" ckd="" or="" non-ckd="" groups="" and="" severe="" hypothyroidism="" (ft4=""><=0.4 ng/dl="" and="" tsh="">=80 μIU/ml) los yog me me mus rau nruab nrab hypothyroidism (FT4<=0.4 ng/dl="" and="" tsh="">=80 μIU / ml). Tus nqi yog qhov nruab nrab ± SD. *P<0.05 and="" **p=""><0.01 versus="" in="" mild="" to="" moderate="" hypothyroidism.="" #=""><0.05 and="" ##p="" <="" 0.01="" versus="" in="" the="" non-ckd="">

Kev sib tham

Txoj kev tshawb no tau pom peb qhov kev tshawb pom tseem ceeb hais txog eGFR hauv cov neeg mob hypothyroidism. Ua ntej, eGFR nce ntxiv tom qab thyroxine supplementation hauv CKD(cmob raum mob)cov neeg mob hauv 6 lub hlis. Txawm hais tias eGFR hauv cov neeg mob CKD tsis tau txhim kho ntxiv tom qab 6 lub hlis hauv kev soj ntsuam ntev, nws muaj peev xwm ua tau ntau yam ua rau lwm yam tsis yog hypothyroidism, suav nrog kev laus, tuaj yeem cuam tshuam rau lub raum tsis ua haujlwm. Qhov thib ob, muaj kev sib raug zoo ntawm qib eGFR thiab qhov hnyav ntawm hypothyroidism, uas tsis muaj hnub nyoog. Tsis tas li ntawd, eGFR hauv cov neeg mob hypothyroid hnyav tau nce mus txog qib zoo ib yam li cov neeg mob hypothyroid me tom qab THRT. Cov kev tshawb pom no qhia tias qhov txo qis ntawm eGFR yog tshwm sim los ntawm kev txo qis cov thyroid hormones thiab lub raum tsis ua haujlwm vim yog hypothyroidism feem ntau tuaj yeem txhim kho los ntawm THRT. Thaum kawg, txawm hais tias qhov hloov pauv hauv cov thyroid ua haujlwm tom qab kev kho mob zoo ib yam hauv CKD(cmob raum mob)thiab cov neeg mob uas tsis yog CKD, eGFR hauv CKD cov neeg mob uas muaj mob me mus rau nruab nrab hypothyroidism tau nce ntxiv tom qab kev kho mob piv rau cov neeg mob uas tsis yog CKD. Cov kev tshawb pom no qhia tias hypothyroidism pab txo qis eGFR hauv cov neeg mob CKD ntau dua li cov neeg mob uas tsis yog CKD.

Hauv tsab ntawv tshaj tawm dhau los, hauv cov neeg mob hypothyroidism uas tau ua rau lub raum biopsies, txhua tus neeg mob tau pom cov kev hloov pauv uas muaj cov tuab ntawm glomerular thiab tubular hauv qab daim nyias nyias thiab sib sau ua ke ntawm ntau hom kev suav nrog hauv cell cytoplasm. Ntxiv rau [1] ntxiv, ob tus neeg mob uas tau kho dua tshiab tom qab kev tswj hwm ntawm cov thyroid hormones pom kev txhim kho hauv cov kab mob anatomical [10]; Txawm li cas los xij, tam sim no, kev hloov pauv hauv lub raum hauv cov neeg mob hypothyroid tsis nkag siab zoo. Daim ntawv tshaj tawm dhau los thiab cov ntaub ntawv tam sim no qhia tias txo GFR raug kho tom qab kho nrog cov thyroid hormone tuaj yeem qhia tias lub raum tsis ua haujlwm yog tshwm sim los ntawm kev ua haujlwm hloov pauv ntau dua li kev puas tsuaj histological [5]. Cov txheej txheem ntawm hypothyroidism cuam tshuam rau lub raum tsis ua haujlwm tau xav tias muaj ntau yam ua rau. Ua ntej, hypothyroidism yog txuam nrog kev txo qis hauv plawv thiab cov ntshav ntim, kev ua haujlwm tsis zoo ntawm renin-angiotensin-aldosterone system, thiab txo qis atrial natriuretic yam theem, uas tuaj yeem ua rau lub raum tsis zoo [11-14]. Thib ob, lim dej ntau dhau los ntawm qhov tsis txaus sodium thiab dej reabsorption hauv cov tubule ze ze tuaj yeem ua rau hloov pauv preglomerular vasoconstriction [15]. Qhov thib peb, hypothyroid [1] ism ua rau txo qis ntawm insulin-zoo li kev loj hlob 1 (IGF1) thiab vascular endothelial kev loj hlob yam (VEGF). IGF1 tsub kom lub hauv pliaj ntshav khiav thiab creatinine tshem tawm hauv tib neeg, thiab VEGF nce endothelial nitric oxide synthase kev ua si, pab txhawb lub zog ntawm lub raum vasculature [16].

Cistanche-lub raum ua haujlwm

Nws paub tias thyroid hormone physiology hloov pauv hauv CKD(cmob raum mob)cov neeg mob. Cov kev hloov pauv no tuaj yeem suav nrog nce TSH tus nqi nce ntxiv, txo TSH cov lus teb rau TRH, txo qis lossis tsis muaj TSH diurnal atherosclerosis, TSH glycosylation txawv txav, thiab txo qis TSH thiab TRH tshem tawm tus nqi [17]. Tsis tas li ntawd, cov ntshav tsis muaj T3 thiab T4 tuaj yeem txo qis, dawb thim rov qab T3 tuaj yeem nce ntxiv, thiab cov ntshav binding protein ntau tuaj yeem hloov pauv [17]. Uremia thiab mob metabolic acidosis txuam nrog CKD(cmob raum mob)tuaj yeem ua rau cov teebmeem no [18]. Tsis tas li ntawd, cov ntshav siab iodine concentration tau tshaj tawm hauv CKD(cmob raum mob)Cov neeg mob [7], thiab qhov iodide ntau dhau tuaj yeem ua rau hypothyroidism los ntawm kev puas tsuaj hauv kev thauj mus los ntawm sodium iodide, iodine organization, thiab thyroid hormone synthesis thiab secretion ntawm Wolff-Chaikoff effect [8]. Tseeb, muaj ib tsab ntawv ceeb toom tias kev txwv tsis pub noj iodine tuaj yeem kho hypothyroidism hauv cov neeg mob uremic ntawm hemodialysis [19].

Cov kev tshawb fawb yav dhau los tau pom tias hypothyroidism ua rau txo qislub raum ua haujlwm[2–5], thiab, ntawm qhov tsis sib xws, lub raum tsis ua haujlwm ua rau txo qis cov thyroid ua haujlwm [6]. Peb qhov kev tshawb pom qhia tias hypothyroidism cuam tshuam eGFR hauv CKD(cmob raum mob)cov neeg mob ntau dua li cov uas tsis yog CKD(cmob raum mob)cov neeg mob; Yog li, hypothyroidism yog suav tias yog ib qho ntawm cov kev pheej hmoo rau kev loj hlob ntawm CKD(cmob raum mob). Nws tau raug tshaj tawm tias feem ntau ntawm hypothyroidism, suav nrog subclinical, yog siab heev hauv cov neeg mob CKD [6]. Yog li ntawd, cov neeg mob CKD yuav tsum tau kuaj xyuas cov thyroid ua haujlwm zoo, thiab THRT tsim nyog yuav tsum tau pib yog tias xav tau.

Cov neeg mob nrog CKD(cmob raum mob), txawm tias cov neeg nyob rau theem pib ntawm qhov teeb meem, tsis yog tsuas yog muaj kev pheej hmoo rau kev loj hlob mus rau theem kawg ntawm lub raum kab mob tab sis kuj muaj kev pheej hmoo siab rau kab mob plawv (CVD). Muaj ntau yam, xws li dyslipidemia, ntshav qab zib, thiab ntshav siab, uas koom nrog CKD(cmob raum mob), yog txuam nrog kev pheej hmoo ntawm CVD [20]. Ntxiv rau qhov kev pheej hmoo ntawm CVD classical, CKD(cmob raum mob)Nws kuj tseem cuam tshuam nrog kev paub txog kev pheej hmoo tshiab rau kev txhim kho atherosclerosis, suav nrog kev mob ntev thiab oxidative stress [20], erythropoietin tsis kam thiab ntshav ntshav [21], vitamin D deficiency [22], thiab vascular calcification [23]. Ntawm qhov tod tes, txawm tias qhov nce me me ntawm TSH tau pom los ua kom muaj kev pheej hmoo rau kev loj hlob ntawm CVD [24]. Cov thyroid hormone cuam tshuam yuav luag txhua lub cev hauv lub cev. Tus naj npawb ntawm cov kev pheej hmoo rau CVD, suav nrog ntshav siab, dyslipidemia, thiab hyperhomocysteineemia, yog nce hauv cov neeg mob hypothyroid [25]. Tsis tas li ntawd, Lekakis et al. [26] pom tau tias cov dej ntws-mediated, endothelium-dependent vasodilatation, ib qho cim ntawm endothelial muaj nuj nqi, tsis tau tsuas yog nyob rau hauv cov neeg mob uas mob me hypothyroidism, tab sis kuj nyob rau hauv cov neeg uas muaj subclinical hypothyroidism. Vim tias muaj feem cuam tshuam rau CVD sib tshooj ntawm CKD(cmob raum mob)thiab hypothyroidism, hypothyroidism tuaj yeem ua rau muaj kev pheej hmoo rau kev loj hlob ntawm CVD nrog kev ua phem ntawm CKD.(cmob raum mob). Kev soj ntsuam ntxiv ntawm kev pheej hmoo rau CVD hauv CKD(cmob raum mob)Cov neeg mob hypothyroidism yuav tsum tau.

Muaj qee qhov kev txwv ntawm qhov kev tshawb fawb no. Ua ntej, qhov no yog kev tshawb nrhiav rov qab nrog cov qauv me me. Thib ob, zoo li hauv ntau lwm cov kev tshawb fawb, peb siv creatinine-raws li kev kwv yees ntawm GFR. Cov qib creatinine hauv cov ntshav tuaj yeem cuam tshuam los ntawm creatinine tiam los ntawm myopathy thiab rhabdomyolysis hauv hypothyroidism; Txawm li cas los xij, kev tshawb fawb siv inulin lossis 51CrEDTA tshem tawm los kwv yees GFR, uas nws txoj hauv kev tsis nyob ntawm qib creatinine, tau tshaj tawm tias kev ua haujlwm glomerular txo qis thaum lub sijhawm hypothyroidism, thiab nce qib creatinine hauv cov neeg mob no tsis yog qhov tshwm sim ntawm kev cuam tshuam ntawm creatinine metabolism [12. , 27, 28] ib. Third, CKD(cmob raum mob)tau categorized siv tsuas yog eGFR qhov tseem ceeb, thiab lwm yam kev tshawb pom ntawm lub raum puas, xws li proteinuria lossis hematuria, tsis tau siv hauv txoj kev tshawb no. Plaub, vim tias txoj kev tshawb no tau ua nyob rau hauv Nyij Pooj, uas suav hais tias yog thaj chaw muaj iodine txaus, cov txiaj ntsig yuav tsis siv rau lwm lub tebchaws uas tsis muaj kev noj haus iodine txaus. Txawm hais tias cov kev txwv no, nws yuav tsum raug sau tseg tias eGFR hauv CKD(cmob raum mob)pawg nrog hypothyroidism tau nce ntxiv tom qab kev kho mob piv rau cov uas tsis yog-CKD pawg hauv txoj kev tshawb no. Rau qhov zoo tshaj plaws ntawm peb txoj kev paub, tsis muaj ntawv ceeb toom txog kev cuam tshuam ntawm hypothyroidism ntawm eGFR hauv CKD(cmob raum mob)cov neeg mob piv rau cov neeg mob uas tsis yog CKD; Txawm li cas los xij, xav tau kev tshawb fawb ntxiv kom paub meej seb puas muaj kev cuam tshuam rau hypothyroidismlub raum ua haujlwmhauv CKD(cmob raum mob)cov neeg mob.

Hauv kev xaus, hypothyroidism pab txo qis hauv eGFR, tshwj xeeb tshaj yog hauv CKD(cmob raum mob)cov neeg mob. Vim tias muaj qhov tshwm sim ntawm thawj hypothyroidism hauv CKD(cmob raum mob)Cov neeg mob, lawv yuav tsum tau kuaj xyuas cov thyroid ua haujlwm zoo, thiab tsim nyog THRT yuav tsum pib yog tias xav tau.

Cistanche tuaj yeem txhim kholub raum ua haujlwm

Los ntawm: 'Cov thyroid hormone hloovKev kho rau thawj hypothyroidism ua rau muaj kev txhim kho tseem ceeb ntawmlub raum ua haujlwmhauvmob raum mobcov neeg mob los ntawmYuji Hataya et al.

--- Clin Exp Nephrol (2013) 17:525–531 DOI 10.1007/s10157-012-0727-y

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