Korean Journal of Nephrology 1997;16(2):316-322.
혈액투석 환자에서 혈청 TSH 농도와 영양상태와의 연관성
김문재 , 이승우 , 권건호 , 김경아 , 김명식 , 김미림
Abstract
Nutrition influences thyroid function. To inve- stigate the association of malnutrition with thyroid function(especially serum TSH level), we performed cross-sectional study in 47 clinically stable HD patients. Thymid function test[TSH and free T4 (Fte), anthropometry[triceps skinfold thickness (TSF), midarm muscle circumference MAMC), BMI, and fractional deviation from ideal weight(FW)], and biochemical parameters[serum albumin(SA), insulin- like growth factor-1(IGF-I) and lymphocyte count (LC)J were measured. All patients were euthyroid state(TSH 0.89±0.52, 0.19-2.82@pU/ml; FT4 0.99± 0.25, 0.38-1.89ng/dl). Patients were divided into two groups according to mean TSH level: group I( > 0.89U/ml, n=@Z4) and group II(<0.89U/ml, n=23). Malnourished patients were significantly more(79.2 vs. 47.8%) and SA(4.0±0.5 vs. 4.4±0.3g/dl), IGF-I (174.5±76.7 vs. 229.3±89.6ng/ml), and BMI (20.8 ±2.5 vs. 22.3±2.1kg/m) were significantly(p<0.05) lower in group I than in II. The proportions of patients with SA of <4.0g/dl and LC of <1200/mm (33.3 vs. 4.3%) and FW of < -0.10(29.2 vs. 4.3%) were significantly more in group I. Group I seemed to have longer duration of HD(53.3±37.2 vs. 36.0+ 28.7 months), lower FT4 (0.52±0.19 vs. 1.05±0.28ng/ dl) and LC(1239.3±455.6 vs. 1498.1±557.4 cells/ mm), and more DM(20.8 vs. 4.3%) and number of patients with TSF(45.8 vs. 13.0%) and MAMC (41.7 vs. 17.4%) of <5 percentile of normal Korean value. TSH showed significantly negative correlation with SA(r=-0.34) and IGF-I(r=-0.35). In conclusion, inadequate HD and malnutrition seem to affect serum TSH level to minimize the energy expenditure in long-term HD patients.
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