血液透析施行中の慢性腎不全患者における甲状腺機能に関する研究--特に1回血液透析の影響について
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Patients with chronic renal failure undergoing long-term hemodialysis (HD) often exhibit laboratory findings suggestive of hypothyroidism. However, the influence of a single HD on thyroid function has not been well understood, so far; therefore, we have undertaken to investigate this problem.<BR>In this study, we investigated 20 patients receiving HD, 15 men and 5 women, ages ranging from 23 to 71 and their mean duration of HD was 16.4 months. Blood samples were taken before, immediately after and 48 hours following a single hemodialysis, then plasma thyroxine (T<SUB>4</SUB>), triidothyronine (T<SUB>3</SUB>), reverse-T<SUB>3</SUB> (rT<SUB>3</SUB>), T<SUB>3</SUB> uptake (T<SUB>3</SUB>U), thyrotropin (TSH) and total protein (TP) were measured.<BR>To investigate the influence of chronic HD on thyroid function, the patients were divided into 2 groups, one with HD for 6 months or less (Group A) and the other with HD for 7 months or more (Group B), and the various parameters of the thyroid function of both groups were compared to each other or with controls.<BR>The influence of heparin, used with HD on the parameters of thyroid function, was also preliminarily studied in 5 normal volunteers, but there was no significant difference between the values of these parameters obtained before and after the heparin infusion.<BR>After a single HD, no significant changes were observed in the corrected values of T<SUB>4</SUB>, T<SUB>3</SUB>U, TSH, FT<SUB>4</SUB>I and FT<SUB>3</SUB>I for TP. The values of rT<SUB>3</SUB> and rT<SUB>3</SUB>/T<SUB>4</SUB>, corrected for TP, significantly increased after a single HD from 14.4±6.8 to 20.4±8.3 ng/100 ml and from 2.8+1.2 to 3.9+1.5, respectively, and returned to the previous levels 48 hours later. The corrected values of T<SUB>3</SUB> and T<SUB>3</SUB>/T<SUB>4</SUB> were found to slightly decrease after a single HD.<BR>As for the influence of chronic HD, no significant difference was observed between T4 concentrations of Group A and controls, but T<SUB>4</SUB> concentration was significantly lower in Group B than in controls. On the other hand, T<SUB>3</SUB> concentration was lower in Group A than in controls, and insignificantly higher in Group A than in Group B. The concentration of rT<SUB>3</SUB> was significantly lower in Group A than in controls and significantly lower in Group B than in Group A. T<SUB>3</SUB>U value was significanly higher in Group A than in controls, but no significant difference was found between the values of Groups A and B. TSH concentration was within normal range in both groups FT<SUB>4</SUB>I and FT<SUB>3</SUB>I showed similar changes with total T<SUB>4</SUB> and T<SUB>3</SUB>, respectively.<BR>These results indicate that there is an increase in the conversion of T<SUB>3</SUB> from T<SUB>4</SUB> by a single HD, thyroid hormones will be gradually decreased with a decrease of thyroxine-binding globulin by repeated HD and, finally, mild hypothyroidism will be induced by longterm HD.
- 学校法人 昭和大学・昭和医学会の論文
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