Effects of thyroid hormone on serum lipid abnormality in patients on maintenance hemodialysis

慢性腎不全患者の血清中性脂肪 (TG) 高値, high density lipoprotein-cholesterol (HDL-C) は低値であり, 一方血清intermediate density liporotein (IDL) 高値で, hepatic triglyceride lipase (H-TGL) 活性の低下が特徴的であった. 血清甲状腺ホルモンの測定では, triiodothyronine (T3) レベルおよびthyroxine (T4) レベルは, 両者とも正常人に比し有意に低下していたが, 甲状腺刺激ホルモン (TSH) は正常範囲内にあった. PAG電気泳動法 (PAGE法) による血清リポ蛋白パターンを検討すると, 約50%に異常パターンが観察された. また慢性腎不全患者においては, H-TGL活性と血清IDLの間に負の相関が, H-TGL活性とT3レベルとの間に弱い正の相関がみられるとの報告がある.以上の事実より, 24例の長期安定透析 (HD) 患者に対し甲状腺ホルモン補充療法を検討したところ, 投与後血清total cholesterol (TC), TGは有意に減少し, HDL-Cの変化はみられなかったが, Atherogenic index (AI) の有意な改善が認められた. 血清very low density liporotein (VLDL), IDLの減少がみられ, low density lipoprotein (LDL) の増加および化学組成の改善があり, lipoprotein lipase (LPL) 活性に変化がみられなかったがH-TGL活性の増加が認められた. PAGE法による血清リポ蛋白の異常パターンの改善が数例に観察された.HD患者に対する甲状腺ホルモン投与によるIDL減少を伴うVLDLの代謝改善には, H-TGL活性の増加も1つの要因になっていることを示唆する成績であった.

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