The Influence Of The Nutritional Status For L-thyrord Hormone Replacement Therapy In Patients With Chronic Kidney Disease With Hypoththyroidism

ObjectiveThe purpose of this study is to make sure the association with hypothyroidism andchronic kidney disease, chronic kidney disease stage3-4analysis of subclinical thyroidfunction and decrease the patients status of nutritional, and the application ofL-thyroxine treatment of subclinical hypothyroidism, can improve the nutritional statusof patients with chronic kidney disease and delay the progression of renal disease in acertain extent.MethodsAccording to the estimated glomerular filtration rate of eGFR,190cases of CKD3-4patients were included, of which CKD3group (n=90), CKD4group (n=100), immuneindex collection admission of patients with age, sex, weight, height, blood biochemicalexamination, thyroid function, asked in detail about the condition of the patients withprimary disease, medication history, history, carries on the analysis to evaluation ofserum albumin, hemoglobin, two groups of patients with hand grip strength and SGAsubjective and objective nutritional status. Then each group of patients with thyroidfunction in peripheral blood sample of test results is divided into the following twogroups: a group, TSH in the normal range, FT3, FT4have no obvious abnormity,defined as non subclinical hypothyroidism group. Group B only increased TSHdefinition of subclinical hypothyroidism group. Then the subclinical thyroid functiondecrease3-4period were divided into control group,group a(n=135) and experimentalgroup b (n=55), the CKD3group was divided into a3(n=65) and b3(n=25), CKD4group was divided into a4(n=70) and b4(n=30).The experimental group received theleft thyroid hormone replacement therapy, initially given25μ g/d oral, according to theillness after adjusting the dose,1times a month to detect serum TSH concentration, the simultaneous detection of T3and T4changes. When the concentration of TSHdecreased to normal range, detection of the above indexes changed1times every3months, followed up for18months. Using SPSS13.0on the collected data werestatistically analyzed.Results(1)In the exclusion of other factors (such as height, advance gender, age); change ofTSH CKD3and CKD4thyroid replacement after complete, independent samples t test,P value of>0.05, no significant difference.(2)After the treatment,CKD3b and CKD4b eGFR completely independentsamples t test, P value <0.0.5, with significant difference. And the CKD3b groupchanges more obviously than CKD4b group.(3)Before treatment,non-subclinical hypothyroidism and subclinicalhypothyroidism group, nutrition assessment is as follows: the plasma albumin level(30.98±3.68g/L vs28.92±5.27g/L, P <0.05), hemoglobin level (113.58±18.33g/L vs99.76±17.66g/L, P=0.001), the left hand (182.80±84.71N vs142.5±61.64N, P <0.05) and right hand grip strength (199.60±182.18N VS162.82±69.05N, P <0.05)were significantly decreased.(4)After the left thyroid hormone replacement treatment, the nutritional index ofchronic kidney disease patients with subclinical hypothyroidism changes, plasmaalbumin level (29.87±4.72g/L vs28.93±5.29g/L, P <0.05), hemoglobin level (103.53±13.75g/L vs99.77±17.67g/, L, P=0.001), the left hand (152.87.00±35.58N vs143.5±61.65N, P <0.05) and the right hand grip strength (178.70±47.45N1, VS162.83±69.07N, P <0.05), the above indexes were compared with alternative before treatmentincreased relatively, independent sample test, statistically significant.Conclusion(1)After the left thyroid hormone therapy in subclinical hypothyroidism patientswith chronic kidney disease in patients with, CKD3group and CKD4group thyroidfunction recovered to the normal range, no significant differences and thyroid recoverydegree.(2)Stage CKD3-4patients with subclinical hypothyroidism after thyroid hormonetreatment, eGFR significantly improved compared with before,the CKD3group wasimproved more significantly than CKD4group.(3)Nutritional evaluation of subclinical hypothyroidism group were lower than thatof non-sub clinical hypothyroidism group, compared the serum albumin, two groups of hemoglobin, hand grip strength and SGA,numerical decreased, that state of malnutritionin subclinical hypothyroidism group was more obviously.(4)The left thyroid hormone replacement therapy in chronic kidney disease stage3-4patients with subclinical hypothyroidism patients,observe the nutrition indexes beforethe treatment was improved, namely plasma albumin, hemoglobin level, left and righthand grip strength, SGA has a certain degree of improvement. As indicated by thesubclinical hypothyroidism because of malnutrition in chronic renal failure state, afterthyroid hormone replacement therapy after partial recovery. To provide basis forclinicians to choose the timing of treatment.