慢性腎不全, 血液透析治療中の甲状腺ホルモン分泌代謝異常に関する臨床的研究
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In order to investigate the abnormalities of thyroid hormone secretion and metabolism in patients with chronic renal failure, plasma thyrotropin releasing hormone (TRH), thyrotropin (TSH), thyroxine (T4), 3, 3', 5-triiodothyronine (T3), 3, 3', 5'-triiodothyronine (rT3), 3, 3'-diiodothyronine (3, 3'-T2), free thyroxine (FT4) and thyroxine binding globulin (TBG) levels were measured by each radioimmunoassay and thyroxine binding prealbumin (TBPA) by the immunodiffusion method in 67 patients on hemodialysis. The effects of hemodialysis on thyroid hormone levels were also evaluated by measuring each parameter before and after hemodialysis in 12 patients. In 8 patients, thyroid hormone levels were serially measured for 16 weeks before hemodialysis. The following results were obtained.<BR>1. Mean plasma TRH and TSH concentrations were 17.3 ± 4.0 pg/ml (Mean± SE) and 2.5±0.80μU/ml, respectively. These values were essentially the same as those in agematched control groups.<BR>2. Mean plasma T4, FT4 and T3 concentrations were 5.9 ± 0.24μg/dl, 1.4 ± 0.08 ng/dl and 97 ± 5.0 ng/dl, respectively, and all these values were lower than normal. These differences were statistically significant (P<0.001).<BR>3. Mean plasma rT3 concentration was 25.6± 1.2 ng/dl and 3, 3'-T2 was 8.1 ± 0.39 ng/dl, which was higher than normal (P<0.005).<BR>4. Mean TBG concentration was 20.2 ± 0.67 μg/ml, whereas TBPA was 18.9 ± 1.6 mg/dl, lower than normal (P<0.001).<BR>5. There were no significant sex differences between thyroid hormone levels. Mean plasma rT3 value increased with aging. Mean plasma T4 and T3 had a tendency to fall with duration of hemodialysis; rT3, however, tended to increase.<BR>6. Neither thyroid hormone levels (T4, T3, rT3 and 3, 3'-T2) nor blood urea nitrogen and creatinine amounts correlated with each other. Minimal correlation was shown between rT3 or 3, 3'-T2 and T3, while there was an inverse correlation between rT3/T3 and T4 (P<0.01).<BR>7. Hormone levels obtained before and after hemodialysis demonstrated that rT3, 3, 3'-T2 and FT4 varied after hemodialysis, but on long-term hemodialysis, thyroid hormone levels were stationary.<BR>These results suggest the following : <BR>The hypothalamic function in the cases of chronic renal failure seems to be normal, whereas the pituitary is quite variable, with some normal and some abnormal. Also, thyroid hormone secretion may be disturbed.<BR>Thyroid hormone metabolic abnormalities may depend on metabolism in a number of peripheral organs, affecting either a deiodinated pathway from T4 to T3 or rT3. These metabolic abnormalities are modified by single hemodialysis and tend to be prevented during the course of long-term hemodialysis.
- 日本内分泌学会の論文