Thyroid：THRT能减慢CKD患者肾功能下降速度

亚临床甲状旁腺功能减退（SCH）在女性、老年人、或者慢性肾脏疾病（CKD）患者中并不是一种罕见的疾病。尽管先前的研究证明甲状腺激素替代治疗（THRT）在SCH患者可以改善心脏功能和血脂紊乱，关于在伴有SCH的CKD患者中，THRT是否可以改善肾功能仍不清楚。为了调查在伴有SCH的CKD患者人群中，THRT对估算肾小球滤过率（eGFR）变化的影响，来自韩国翰林大学医学院Shin Wook Kang教授及其团队进行了一项研究，该研究发现在伴有SCH的CKD患者中，THRT能减慢肾功能下降的速度，提示THRT可延迟这些患者到达终末期肾脏疾病的时间。该研究结果发表在2013年6月的《甲状腺》（Thyriod）杂志上。

该研究，在2005年1月至2011年12月期间，共有113例接受左旋甲状腺素治疗、并有THRT前后至少24个月eGFR的伴有SCH的CKD患者入选。使用线性混合模型比较不同时间点患者的临床和生化指标。同时在THRT前后，使用线性混合模型计算和比较eGFR随时间下降的斜率。

该研究结果表明，研究对象的平均年龄为63.2±12.7岁，且36例患者（31.9%）为男性。THRT前后平均随访时间分别为28.6±4.5和30.6±6.4月。THRT24个月后，血清促甲状腺激素（TSH）水平显著下降（8.86±0.49 vs 1.41±0.73uIU/ml，p＜0.001），但三碘甲状腺原氨酸和游离甲状腺素浓度的变化没有意义。同时比较THRT前后血清白蛋白、钙、磷酸盐、胆固醇、以及甘油三脂水平。即使校正年龄、性别、糖尿病、平均动脉血压、血清白蛋白、胆固醇、以及甘油三酯浓度后（p＜0.001），THRT显著减慢eGFR下降的速度（-4.31±0.51 vs -1.08±0.36[ml/min]/[年·1.73m²]，p＜0.001）。

该研究发现，在伴有SCH的CKD患者中，THRT能减慢肾功能下降的速度，提示THRT可延迟这些患者到达终末期肾脏疾病的时间。

Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism.
Abstract
Background: Subclinical hypothyroidism (SCH) is not a rare condition in females, the elderly, or patients with chronic kidney disease (CKD). Even though previous studies have demonstrated that thyroid hormone replacement therapy (THRT) improves cardiac function and dyslipidemia in patients with SCH, it remains unclear as to whether THRT can improve renal function in CKD patients with SCH. This study investigated the impact of THRT on changes in estimated glomerular filtration rates (eGFR) in this patient population. Methods: A total of 113 CKD patients with SCH who were treated with L-thyroxine and had eGFR available for at least 24 months before and after THRT were enrolled between January 2005 and December 2011. A linear mixed model was used to compare patients' clinical and biochemical parameters at various time points. The slope of the decline in eGFR over time, both before and after THRT, was also calculated and compared using a linear mixed model. Results: The mean age of the study participants was 63.2±12.7 years, and 36 patients (31.9%) were men. The mean follow-up duration before and after THRT was 28.6±4.5 and 30.6±6.4 months respectively. After 24 months of THRT, serum thyrotropin (TSH) levels were significantly reduced-8.86±0.49 versus 1.41±0.73 μIU/mL, p<0.001-but there were no significant changes in triiodothyronine and free thyroxine concentrations. Serum albumin, calcium, phosphate, cholesterol, and triglyceride levels were also comparable before and after THRT. The rates of decline in eGFR were significantly attenuated by THRT (-4.31±0.51 vs.-1.08±0.36 [mL/min]/[year·1.73 m(2)], p<0.001), even after adjustment for age, sex, diabetes, mean arterial pressure, and serum albumin, cholesterol, and triglyceride concentrations (p<0.001). Conclusion: THRT attenuated the rate of decline in renal function in CKD patients with SCH, suggesting that THRT may delay reaching end-stage renal disease in these patients.