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在各种激素的产生和代谢过程中肾脏起着中心作用。此外,慢性肾衰导致的内环境改变,可影响激素的合成和分泌速度,同样会引起激素在靶组织的效应改变,比如“尿毒症性假性糖尿病”可作为一个例证。血浆不同激素水平变化的结果,造成了与尿毒症病人处理实际有关的实验室检查解释上的困难。本文特别强调尿毒症病人内分泌功能改变所造成的诊断和治疗上的困境。甲状腺功能在尿毒症中,甲状腺激素的生理特征是在多种水平变化。甲状腺素与血浆蛋白的结合度降低,外周甲状腺素(T_4)转变为三碘甲状腺氨酸(T_3)减少,因此,常常在血清中倒置的T_3水平无增加。甲状腺对外源性甲状腺刺激素(TSH)的反应常常是正常的,但是,在一定的百分比病人中,表现出脑垂体对促甲状腺释
The kidneys play a central role in the production and metabolism of various hormones. In addition, the changes in the internal environment caused by chronic renal failure can affect the hormone synthesis and secretion rate, also can cause hormone effects in the target tissue changes, such as “uremic pseudo-diabetes” can be used as an example. Changes in plasma levels of different hormones have caused difficulties in interpretation of laboratory tests related to the actual treatment of uremic patients. This article highlights the diagnostic and therapeutic predicaments caused by changes in endocrine function in uremic patients. Thyroid function In uremia, the physiological characteristics of thyroid hormones vary at many levels. Thyroxine and plasma protein binding decreased, thyroid hormone (T_4) into triiodothyronine (T_3) decreased, therefore, often in the serum inverted T_3 level did not increase. Thyroid responses to extrinsic thyroid stimulating hormone (TSH) are often normal, however, in a certain percentage of patients, the effect of the pituitary gland on thyroid-releasing