摘要
目的 分析维持性血液透析（MHD）患者甲状腺激素水平与颈动脉病变的关系及其评估价值.方法 选择2014年6月至2016年7月在我院血液透析中心治疗的MHD患者121例,根据颈动脉彩色超声检查是否存在斑块或狭窄情况,将患者分为颈动脉正常组和颈动脉病变组.收集患者颈动脉病变情况及相关临床资料,对可能影响颈动脉病变的单因素进行分析,利用多因素Logistic回归分析颈动脉病变的独立危险因素,并用OR值最大的独立危险因素尝试建立其评估MHD患者颈动脉硬化的ROC曲线.结果 颈动脉病变组的血钙、TC、TG、LDL？C、促甲状腺素（TSH）、CRP、同型半胱氨酸（Hcy）水平高于正常组（P均〈0.05）,病变组的血磷、游离三碘甲状腺原氨酸（FT3）水平低于正常组（P均〈0.05）.颈动脉粥样硬化相关危险因素的多因素Logistic回归分析可见,CRP（OR=1.620,95%CI 1.288~2.038,P=0.048）,Hcy（OR=1.976,95%CI 1.135~3.441,P=0.021）,FT3（OR=2.521,95%CI 1.584~4.012,P=0.017）均为颈动脉独立危险因素.FT3评估颈动脉硬化的ROC曲线下面积（AUC）=0.848,P=0.000,诊断切点为3.705 pmol/L,诊断敏感度为0.670,特异性为0.879;CRP评估颈动脉硬化的ROC曲线AUC=0.619,P=0.000,诊断切点为16.215 mg/L,诊断敏感度为0.932,特异度为0.333;Hcy评估颈动脉硬化的ROC曲线AUC=0.767,P=0.044,诊断切点为12.565μmol/L,此时诊断的敏感度为0.784,特异度为0.881.结论 MHD患者低浓度FT3、高浓度Hcy、高浓度CRP均为颈动脉病变的独立危险因素.利用FT3水平评估颈动脉硬化具有一定价值.
Objective To investigate the relationship between thyroid hormone levels and carotid artery disease in maintenance hemodialysis （ MHD ） patients and evaluate its value. Methods Clinical data of one hundred and twenty？one MHD patients during January 2014 to July 2016 in Yanan University Affiliated Hospital were collected. The patients were divided into the normal carotid artery group and the carotid artery lesion group according to whether there was plaque or stenosis in the carotid artery ultrasonography. Clinical data related to the carotid artery lesions was collected, and the single factors that may affect the carotid artery lesions were analyzed,multivariate logistic regression was used to analyze independent risk factors for carotid artery disease, and the greatest independent risk factor of OR value was used to establish a ROC curve for evaluating carotid atherosclerosis in patients with MHD. Results The levels of serum calcium, TC, TG, LDL？C, TSH, CRP and Hcy in the carotid artery group were higher than those in the normal group （ P〈0. 05 ） . The levels of serum phosphorus and FT3 in the lesion group were lower than those in the normal group （ P〈0. 05 ） . Multivariate logistic regression analysis of risk factors for carotid atherosclerosis showed that CRP （ OR=1. 620,95%CI1. 288-2. 038,P=0. 048）,Hcy （OR=1. 976,95%CI 1. 135？3. 441,P=0. 021）,FT3 （OR=2. 521,95%CI 1. 584-4. 012,P=0. 017） were independent risk factors for carotid artery disease. FT3 evaluation of the ROC curve showed AUC=0. 848,P=0. 000,the cut？off value was 3. 705pmol/L,the diagnostic sensitivity was 0. 670,and the specificity was 0. 879. CRP valuation of the ROC curve suggested that AUC=0. 619,P=0. 000,the cut？off value was 16. 215 mg/L,the diagnostic sensitivity was 0. 932 and the specificity was 0. 333. Hcy evaluation of the ROC curve showed AUC=0. 767,P=0. 000,the cut？off value was 12. 565μmol/L,the diagnostic sensitivity was 0. 784 and the specificity was 0. 881. Conclusion Low concentration of FT3
作者
雒华
贺晓莉
杨小娟
刘晓华
Luo Hua He Xiaoli Yang Xiaojuan Liu Xiaohua(Department of Nephrology, Yanan University Affiliated Hospital, Yanah 716000, China)
出处
《中国综合临床》
2017年第9期819-823,共5页
Clinical Medicine of China
