Thyroid Hormone Is Related to Postoperative AKI in Acute Type A Aortic Dissection.
Thyroid Hormone Is Related to Postoperative AKI in Acute Type A Aortic Dissection.
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甲状腺激素与急性 A 型主动脉夹层术后 AKI 相关。
DOI：
10.3389/fendo.2020.588149
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发表时间：
2020
影响因子：
5.2
通讯作者：
Zhao Y
中科院分区：
文献类型：
--
作者：
Liu J;Xue Y;Jiang W;Zhang H;Zhao Y
肾功能受甲状腺激素水平的影响很大。本研究旨在探讨急性A型主动脉夹层(ATAAD)患者术前甲状腺激素水平与术后急性肾损伤(AKI)的关系。研究对象为2016年7月至2016年12月在北京安贞医院接受手术治疗的ATAAD患者88例，健康对照组274例。采用倾向-得分匹配法比较甲状腺激素水平。此外，在对ATAAD患者进行的一项队列研究中，进行了多变量回归和分层分析，以检查术前甲状腺激素与术后AKI的关系。与健康对照组比较，ATAAD患者术前总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)水平降低(P<0.01)，游离甲状腺激素(FT4)水平升高(P<0.01)。术后AKI总发生率为45.5%。多因素回归分析显示，低TT3水平(OR=0.07，95%CI，0.01~0.86，P=0.04)与术后AKI独立相关。亚组分析显示，促甲状腺激素水平正常的患者与AKI显著相关(OR=0.001·95%CI，0.001~0·16，P<0·01)，而在促甲状腺激素水平较低的患者中无相关性(P=0·12)。本研究表明，低水平的TT3是ATAAD患者术后AKI的预测指标，尤其是在TSH正常的患者。ATAAD患者手术前应检查甲状腺功能，低T_3者术后AKI风险较高。
Renal function is profoundly influenced by thyroid hormone levels. This study was designed to evaluate the association between preoperative thyroid hormones and postoperative acute kidney injury (AKI) in acute type A aortic dissection (ATAAD) patients. A total of 88 patients with ATAAD who underwent surgeries in Beijing Anzhen Hospital and 274 healthy controls from July 2016 to December 2016 were included in this study. Propensity-score matching was used to compare thyroid hormone levels. Additionally, in a cohort study of ATAAD patients, multivariable regression and stratification analyses were conducted to examine the association of preoperative thyroid hormones with postoperative AKI. Compared with healthy controls, ATAAD patients presented with lower preoperative levels of total triiodothyronine (TT3) (P < 0.01), free triiodothyronine (FT3) (P < 0.01), and thyroid-stimulating hormone (TSH) (P < 0.01) and a higher preoperative level of free thyroxine (FT4) (P < 0.01). The overall occurrence of postoperative AKI was 45.5%. Multivariate regression revealed that low levels of TT3 (OR = 0.07, 95% CI, 0.01–0.86, P = 0.04) were independently associated with postoperative AKI. Subgroup analyses showed that the association between TT3 and AKI was significant in patients with normal TSH levels (OR = 0.001 95% CI, 0.001–0.16, P < 0.01) but not in patients with lower TSH levels (P = 0.12). The present study showed that a low level of TT3 was a predictor of postoperative AKI in ATAAD patients, especially in patients with normal TSH. The thyroid function should be checked before surgical intervention of patients with ATAAD, and patients with low T3 might be at higher risk of postoperative AKI.
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