The Correlation between The Thyroid Function and Renal Function in Patients with Differentiated Thyroid Cancer under the Short-term Hypothyroidism after Withdrawal of Iodine Therapy
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摘要:
目的 研究分化型甲状腺癌患者在放射性碘治疗前停药后的短期甲减状态下甲状腺功能与肾功能的相关性。 方法 纳入122例DTC术后且适宜行放射性碘治疗的患者，采集入组患者停服左甲状腺激素前与停药后的甲状腺功能水平与肾功能水平等资料，比较停药前与停药后肾功能指标的变化，分析甲状腺功能及相关因素对肾功能的影响。 结果 DTC患者的尿酸、肌酐、eGFR水平在停药后较停药前有所升高；在停药后甲状腺功能减退状态下，男性患者的肌酐、尿酸水平高于女性患者，TSH > 60 mIU/L组的肌酐水平高于TSH≤60 mIU/L组，eGFR水平在TSH > 60 mIU/L组低于TSH≤60 mIU/L组，伴有颈部淋巴结转移组与不伴有颈部淋巴结转移组、甲状腺全切手术组与甲状腺次全切除手术组的肾功能生化指标比较差异均无统计学意义（P > 0.05）；FT4、TT3、TT4水平与eGFR水平呈正相关（r值分别为0.267、0.249、0.330，P < 0.05），年龄与eGFR水平呈负相关（r值为-0.213，P < 0.05），TT4水平与肌酐水平呈负相关（r值为-0.232，P < 0.05）；多重线性回归结果显示，TT4水平、年龄、性别与eGFR水平呈独立相关。 结论 DTC患者在放射性碘治疗前停药后甲减状态下，尿酸、肌酐水平升高，eGFR水平降低；减低的TT4水平、高龄、男性是eGFR水平降低的独立影响因素。 Abstract:Objectives To investigate the correlation between the thyroid function and renal function in patients with the differentiated thyroid cancer in the short-term hypothyroid state after the discontinuation of prior radioiodine therapy. Methods A total of 122 patients with the differentiated thyroid cancer and operated on and suitable for radioiodine therapy were included. The data of thyroid function level and renal function level before and after the withdrawal of levothyroxine in enrolled patients were collected. The changes in renal function measures before versus after the discontinuation were compared and the thyroid function and associated factors on renal function were analyzed. Results The levels of uric acid, creatinine, and eGFR in patients with DTC increased after the treatment discontinuation compared with those before the treatment discontinuation; In the hypothyroid state after the drug withdrawal, male patients had the higher levels of creatinine and uric acid than female patients. The level of creatinine in TSH > 60 miu/l group was higher than that in TSH ≤ 60 miu/l group, and the level of EGFR in TSH > 60 miu/l group was lower than that in TSH ≤ 60 miu/l group. There was no significant difference in biochemical indexes of renal function between cervical lymph node metastasis group and non cervical lymph node metastasis group, total thyroidectomy group and subtotal thyroidectomy group （P > 0.05）; The levels of FT4, TT3 and TT4 were positively correlated with the level of EGFR （r value was 0.267, 0.249 and 0.330, P < 0.05）, age was negatively correlated with the level of EGFR （r value was -0.213, P < 0.05）, and TT4 was negatively correlated with the level of creatinine （r value was -0.232, P < 0.05）; Multiple linear regression showed that TT4 level, age and gender were independently correlated with EGFR level. Conclusion For DTC patients in hypothyroidism after the withdrawal before the radioactive iodine treatment, the levels of uric acid and creatinine increase and the level of eGFR decreases; the reduced TT4 level, old age and male are the independent influencing factors for the decrease of eGFR level. -
表 1 停药前与停药后患者肾功能水平的比较（
$ \bar{x} \pm s $ M/（P25，P75），n = 122）Table 1. Comparison of renal function before and after drug withdrawal（
$ \bar{x} \pm s $ / M（P25，P75），n = 122）组别 尿素（mmol/L） 肌酐（μmol/L） 尿酸（μmol/L） eGFR（mL/min/1.73 m2） 手术前 4.69 ± 1.03 58.00（52.75，68.00） 280.00（231.00，320.00） 106.30（93.66，116.70） 碘治疗前 4.52 ± 1.36 68.00（58.00，79.00） 282.00（234.75，346.00） 89.98（78.40，103.71） t/Z 1.473a 8.342 3.203 8.065 P 0.143 < 0.001 0.001 < 0.001 注：a为t值，其余为Z值，eGFR：估计的肾小球滤过率。 
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表 2 停药后患者相关单因素分组的比较[M（P25,P75）]
Table 2. Comparison of related univariate groups after drug withdrawal[M（P25,P75）]
项目 例数（n） 尿素（mmol/L） 肌酐（μmol/L） 尿酸（μmol/L） eGFR [mL/min·1.73 m2] 性别 男 20 5.08（4.24，614） 89.50（84.75，102.25） 372.00（335.00，419.00） 84.75（74.61，95.76） 女 102 4.21（3.43，5.30） 65.00（57.00，74.00） 272.00（230.50，323.25） 91.57（78.87，107.97） Z 1.929 6.005 4.755 1.604 P 0.054 < 0.001* < 0.001* 0.109 转移情况 是 46 4.46（3.52，5.18） 67.50（58.00，77.25） 268.50（228.50，355.25） 93.22（81.59，105.32） 否 76 4.45（3.49，5.40） 68.00（58.00，81.00） 289.00（245.50，334.75） 84.48（76.91，103.71） Z 0.576 0.040 0.320 1.244 P 0.565 0.968 0.749 0.213 手术方式 全部切除术 87 4.57（3.57，5.31） 69.00（58.00，79.00） 288.00（244.00，352.00） 89.16（78.10，103.64） 次全切除术 35 4.13（3.18，5.49） 67.00（58.00，77.00） 273.00（231.00，323.00） 90.75（78.60，107.43） Z 1.160 1.002 0.849 0.478 P 0.246 0.316 0.396 0.632 自身抗体情况 阳性 33 5.00（3.89，6.29） 65.00（55.00，71.50） 275.00（214.00，326.00） 90.92（79.10，110.64） 阴性 89 4.17（3.37，5.20） 70.00（59.50，83.50） 288.00（246.50，356.00） 89.69（77.94，102.89） Z 2.170 2.208 1.700 0.781 P 0.030 0.027 0.089 0.435 TSH水平 ≤60 32 4.56（3.81，6.01） 59.50（55.00，72.50） 274.50（237.00，358.50） 100.36（88.77，113.04） > 60 90 4.31（3.48，5.24） 70.00（60.00，81.00） 288.00（234.75，343.00） 85.89（76.92，99.04） Z 1.304 2.352 0.038 3.088 P 0.192 0.019 0.970 0.002 注：eGFR：估算肾小球滤过率，TSH：促甲状腺激素。
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表 3 停药后患者相关因素与肾功能的相关性（r）
Table 3. Correlation between related factors and renal function after drug withdrawal （r）
指标 尿素 肌酐 尿酸 eGFR FT3 0.240a 0.026 0.127 0.055 FT4 0.174 −0.155 0.049 0.267a TT3 0.079 −0.171 0.027 0.249a TT4 0.078 −0.232a 0.091 0.330a 年龄 0.057 −0.050 −0.044 −0.213a 停药时间 0.187a 0.076 −0.147 −0.137 BMI指数 0.133 0.092 0.350a −0.101 注：TT3：总三碘甲状腺原氨酸；TT4：总甲状腺素；FT3：游离三碘甲状原氨酸；FT4：游离甲状腺素；eGFR：估算肾小球滤过率；aP < 0.05。
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表 4 eGFR的多因素线性回归分析结果
Table 4. results of multivariate linear regression analysis of eGFR
项目 B 标准误差 标准化系数 t P TT4 0.228 0.076 0.257 2.989 0.003 年龄 −0.451 0.178 −0.218 −2.526 0.013 性别 −9.801 4.687 −0.180 −2.091 0.039 常量 107.616 8.818 12.204 < 0.001 注：因变量：eGFR；TT4：总甲状腺素。
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