The Expression And Relativity Of DIO-1 And Inflammatory Factors In CRF Patients Accompanied With Euthyroid Sick Syndrome

ObjectiveChronic renal failure(CRF)are often accompanied by euthyroid sick syndrome(ESS)and increased inflammatory factors,such as Tumor necrosis factor?(TNF-?).Some studies reported that type 1 iodothyronine deiodinase(DIO-1)pay an important role in ESS.However,the relationship of Triiodothyronine(T3)level and DIO-1 and inflammatory factors in ESS is unclear.In order to provide better references and support for the clinical treatment of ESS associated CRF,we carried out this study to investigate the the expression of DIO-1,IL-1?,IL-6,TNF-? and Oxidative stress factor,such as 8-Isoprostane in CRF patients accompanied with and without ESS,and analyzed of the relativity of biochemical criterion,FT3,DIO-1,IL-1?,IL-6 TNF-? and 8-Isoprostane.MethodsCRF diagnostic criteria referred to Kidney Disease Improving Global Outcomes(KDIGO)formulated in 2013:Ccr<20ml/min or CRE>442umol/L.Hospital patients with CRF in the Second Affiliated Hospital of Nanchang University were recruited from April 2015 to April 2016.According to ESS diagnostic criteria:(FT3<2.3pg/ml)we divided the patients into two groups,Group 1: CRF patient with ESS(n=60);Group 2: CRF patients without ESS(n=60);Group3:control group,the healthy volunteers were recruited from the Community medical examination(n=60).Enzyme-linked immunosorbent assay(ELISA)was used to test the level of DIO-1,inflammatory factors(IL-1? ? IL-6 ? TNF-?)and oxidative stress factor(8-Isoprostane).Then we make a correlated analysis comparing with clinical examination indicator between three groups in gender,age,blood pressure,heart rate,respiratory,body mass index(BMI),Cholesterol,Hemoglobin,Albumin,fasting plasma glucose(FPG),white blood cell,creatinine,uric acid,FT3,Free Thyroxine(FT4)and thyroid stimulating hormone(TSH).Results1.Baseline information of patients:There was no obvious difference in age andsex between Group 1 and Group.Because of the consecutive method of recruitment of Group 3,there was unequal distribution of sex and age in the patients and consequently in the control group.Because patients with CRF are often accompanied by anemia,hypoproteinemia and hyperuricemia,the Hb and ALB in CRF group were lower than those in the normal group.And most of patients with CRF were diabetic nephropathy,so fasting blood glucose of the CRF group was higher than the normal group.The blood pressure,heart rate,respiratory rate,white blood cell,FT4,TSH were not significantly different among the three groups.2.The expression of DIO-1: The expression of DIO-1 in groups 2 was significantly higher than in group 1(2.03±0.16 ng/ml vs1.31±0.08 ng/ml,p<0.001)and the expression of DIO-1 in groups 2 was significantly higher than in group 3(2.03±0.16 ng/ml vs 1.27±0.24 ng/ml P<0.001).Although the expression of DIO-1 in the group 1was higher than that in group 3,the difference was not statistically significant(1.31±0.08 ng/ml vs 1.27±0.24 ng/ml,p=0.976).3.The expression of IL-1?: The expression of IL-1? in groups1 was significantly higher than in group 3(24.69±4.02 pg/ml vs 7.91±1.57 pg/ml,p<0.001)and The expression of IL-1? in groups 2 was significantly higher than in group 3(14.64±1.54 pg/ml vs 7.91±1.57 pg/ml P<0.05).Although the expression of IL-1? in the group 1was higher than that in group 2,the difference was not statistically significant(24.69±4.02 pg/ml vs 14.64±1.54 pg/ml,p=0.056).4.The expression of IL-6:The expression of IL-6 in group 1 and group 2 was significantly higher than in group 3,but the difference was not statistically significant(p=0.145).5.The expression of TNF-?:The expression of TNF-? in groups 1 was significantly higher than in group 3(126.96±11.53 ng/ml vs 64.57±7.14ng/ml,p<0.001)and The expression of TNF-? in groups 2 was significantly higher than in group 3(100.67±12.74 ng/ml vs 64.57±7.14 ng/ml P<0.05).Although the expression of TNF-? in the group 1was higher than that in group 2,the difference was not statistically significant(126.96±11.53 ng/ml vs 100.67±12.74 ng/ml,p=0.339).6.The expression of 8-Isoprostane: The expression of 8-Isoprostane in groups1 was significantly higher than in group 3(17±8.05pg/ml vs4.41±2.47pg/ml,p<0.001)and The expression of 8-Isoprostane in groups 2 was significantly higher than in group 3(15.22±8.4pg/ml vs 4.41±2.47pg/ml,P<0.05).Although the expression of 8-Isoprostane in the group 1was higher than that in group2,the difference was not statistically significant(17±8.05pg/ml vs15.22±8.4pg/ml,p=0.516).7.Regression analysis of multiple factor on DIO-1:By multivariate linear regression analysis,the concentration of serum DIO-1 was inversely correlated with TNF-? concentrations(r =-0.603,P <0.001),positively correlated with creatinine levels(r=0.467,p<0.001),and fT3 levels(r=0.467,p<0.001)).However,there were no significant correlation between IL-1? levels.8.Regression analysis of multiple factor on 8-Isoprostane:By multivariate linear regression analysis,the concentration of serum 8-Isoprostane was positively correlated with TNF-? levels(r=0.265,P<0.001),and IL-1?levels(r=0.41.P=0.002).However,there were no significant correlation between TSH and FT3 levels.Conclusion1.Patients with CRF were almost associated with elevated levels of inflame matory cytokines and oxidative stress.2.The expression of DIO-1 was significantly increased in CRF patients without ESS.We conjected that CRF patients without ESS may maintain the concentration of serum FT3 by elevating the concentration of serum DIO-1.3.By multivariate linear regression analysis,the concentration of serum DIO-1was inversely correlated with TNF-? concentrations,However,there were no significant correlation between IL-1? and IL-6 levels.We propose that the increase of DOI-1 can inhibit the production of serum TNF-?.Further studies are needed to explore the details of the molecular mechanism.