目的 探讨在蛋白质能量消耗(PEW)合并低T3综合征的维持性血液透析(MHD)患者中应用小剂量左甲状腺素钠片纠正低T3血症,对其营养状态、贫血、微炎症、血脂及钙磷代谢、甲状旁腺激素(PTH)水平的影响.方法 筛选PEW并低T3综合征的MHD患者35例,补充小剂量左甲状腺素钠片共12周,观察治疗前后甲状腺功能、骨骼肌、体脂肪、干体重、7P-MGA分值、每日热量摄入量、HB及生化等指标变化.结果 治疗后TT3和TT4、ALB、TG、血磷、干体重、骨骼肌、7P-SGA分值、每日摄入热量均高于治疗前(P<0.05);CRP较治疗前下降(P<0.01);治疗前后体脂肪、TSH、HB、TC、血钙、PTH比较差异无统计学意义(P>0.05).结论 对于并发PEW及低T3综合征的MHD患者,补充小剂量左甲状腺素片有助于改善患者饮食及营养状态,改善机体机能,提高生活质量,可减轻患者微炎症状态,但会导致高磷血症及高三酰甘油血症,此研究未证实该治疗有利于贫血的纠正.%Objective To observe the effects of low-dose levothyroxine sodium tablets on the nutritional status, anemia,micro inflammation,blood lipid,calcium and phosphorus metabolism and PTH levels in patients with PEW and low T3 syndrome receiving mainternance hemodialysis ( MHD) . Methods Thirty-five patients receiving MHD with PEW and low T3 syndrome were treated by low-dose levothyroxine sodium tablets for 12 weeks. The levels of TT3,TT4,TSH,HB,ALB,TC, TG,serum calcium, serum phosphorus, CRP, PTH and the contents of skeletal muscle, body fat, dry weight were detcted, moreover, the 7P-SGA score,daily calorie intakes,HB and biochemical indexes before and after treatment were observed. Results After treatment,the levels of TT3,TT4,ALB,TG,serum phosphorus,dry weight,skeletal muscle,7P-SGA scores and daily calorie intake were significantly higher than those before treatment (P<0. 05),however CRP was lower than that before treatment (P<0. 01). In addition there were no significant differences in body fat,TSH,HB,TC,serum calcium,PTH before and after treatment (P>0. 05). Conclusion For the patients receiving mainternance hemodialysis with PEW and low T3 syndrome,the low-dose levothyroxine sodium tablet is helpful to improve diet and nutritional status of patients,improve body function and life quality,which can also reduce the micro inflammatory state,but,which may lead to hyperphosphatemia and hypertriglyceridemia. This study does not confirm that supplementation of low-dose levothyroxine sodium is beneficial to anemia correction.
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